Catalogue Ⅰ.Teaching Plan

1. MBBS Curriculum for 2009 Grade………………………………………………………………….1

2. MBBS Curriculum for 2010 Grade………………………………………………………………….2

3. MBBS Curriculum for 2011 Grade………………………………………………………………….3

4. MBBS Curriculum for 2012 Grade………………………………………………………………….4

Ⅱ. Syllabus

1. Medical Biology…………………………….……………………………………………………….5

2. Human Anatomy…………………………….……………………………………………………..15

3. Histology and Embryology…………………………….…………………………………………. 39

4. Biochemistry…………………………….………………………………………………….….…...55

5. Medical Genetics………………………………………………………………………………..….72

6. Physiology…………………………….…………………………………………………….…..….84

7. Medical Immunology…………………………………………………………………….…….….102

8. Human Parasitology………………………………………………………………..…………..….118

9. Pathophysiology……………………………………………………………………………….…..130

10. Pathology…………………………………………………………………………………………139

11. Medical Microbiology……………………………………………………………………………155

12. Regional Anatomy………………………………………………………………………………..194

13. Pharmacology…………………………………………………………………………………….206

14. Diagnostics and Electrocardiography…………………………………………………………….226

15. Traditional Chinese Medicine…………………………………………………………………….253

16. Medical Imaging………………………………………………………………………………….262

17. Surgery……………………………………………… …………………………………………...270

18. Internal Medicine ………………………………………………………………………………...321

19. Medical Obstetrics and Gynecology……………………………………………………………343

20. Medical Stomatology……………………………………………………………………………358

21. Neurology and Psychiatry………………………………………………………………………368

22. Pediatrics………………………………………………………………………………………..378

23. Ophthalmology………………………………………………………………………………….392

24. Infectious………………………………………………………………………………………..399

25. Otorhinolaryngology…………………………………………………………………………….406

26. Critical Care Medicine…………………………………………………………………………..418

27. Oncology………………………………………………………………………………………...426

2 MBBS Curriculum for 2009 Grade

Course Hour Weekly distribution per semister 1st 2nd 3rd 4th 5th 6th Course Number Course Credit Exam Theory Laboratory Nature 2 3 2 3 2 3 2 3 2 3 2 3

1 Chinese 23 368 11 5 5 3 + 2 Medical Chinese 8 128 4 4 4 4 + 3 Medical Talk 5 80 4 4 + Compulsory 4 General Situation of China 4 64 4 + 5 Basic Information Technology 4 64 4 + 6 Medical History 2 32 2 - 7 Medical Sociology 2 32 2 - Elective 8 Psychology 2 24 12 2 - 9 Medical Ethics 2 32 2 - General Education 52.0 824 19 7 7 5 4 4 4 4 4 4 10 Human Anatomy 8 80 96 6 6 + 11 Medical Biology 3 32 32 4 + 12 Histology and Embrology 5 64 32 5 + 13 Biochemistry and Molecular 7 80 64 9 + Chemistry 14 Genetics 2.5 32 16 3 + 15 Physiology 7 80 64 8 + Compulsory 16 Immunology 3.5 48 16 4 + 17 Pathology 7 80 64 9 + 18 Medical Parasitology 3 40 16 3 + 19 Pathophysiology 4 48 32 6 + 20 Microbiology 5 64 32 6 + 21 Pharmacology 6.5 80 48 9 + Basic Medicine 61.5 728 512 6 15 20 22 6 9 22 Regional Anatomy 3 24 48 5 + 23 Public Health 3 48 3 + 24 Medical Statistics 2 32 2 + 25 Epidemiology 2 32 2 + 26 Diagnostics 6.5 78 48 8 + 27 Chinese Medicine 3 52 12 4 + 28 Cardiography 1 14 12 2 + 29 Medical Imaging 3.5 48 16 4 + 30 Surgery 1 5 52 52 7 + 31 Anesthesia 0 24 2 + 32 Nuclear Medicine 2 32 2 + 33 Community Medicine 1.5 24 2 + 34 Forensics 2 32 2 + 35 Surgery 2 6 80 32 8 + 36 Medicine 1 6 84 24 7 + Compulsory 37 Gynaecology 5 64 32 5 + 38 Oral Science 1.5 24 2 + 39 Medicine 2 4 52 24 5 + 40 Neurology and Psychiatry 2. 5 40 12 3 + 41 Pediatriacs 5 64 24 6 + 42 Opthalmology 2.5 32 16 3 + 43 Infectious Diseases 2.5 32 16 3 + 44 Dermatology 2.5 32 16 3 + 45 Ear Nose Thoat Surgery 2.5 32 16 3 + 46 ICU 2 32 3 + 47 Oncology 2 32 16 3 + Summary of Medicine 48 5 32 16 6 + I(Internal Medicine ) 49 Summary of Medicine 5 32 16 6 + II(Surgery) Clinical Medicine 86 1156 448 0 12 14 17 24 23 49 Clinical Technique Training 4 32 64 8 + 50 Clinical Practice 48 1440 √ √ + Clinical Technique 51 0.5 √ + Compulsory Examination 52 Graduation Examination 1 0.5 √ + 53 Graduation Examination 2 0.5 √ + Practice 53.5 1472 64 8 Total 253.0 4180.0 1024.0 25.0 22.0 27.0 27.0 22.0 27.0 21.0 28.0 27.0 12.0 Total class hours and the course 5204.0 4 4+1 4+1 5+1 4+1 7.0 6 6 7 5 number of each semester 1

MBBS Curriculum for 2010 Grade

Course Hour Weekly distribution per semister 1st 2nd 3rd 4th 5th 6th Course Number Course Credit Exam Theory Laboratory Nature 2 3 2 3 2 3 2 3 2 3 2 3 1 Chinese 23 368 11 5 5 3 + 2 Medical Chinese 8 128 4 4 4 4 + 3 Medical Talk 5 80 4 4 + Compulsory 4 General Situation of China 4 64 4 + 5 Basic Information Technology 4 64 4 + 6 Medical History 2 32 2 - 7 Medical Sociology 2 32 2 - Elective 8 Psychology 2 24 12 2 - 9 Medical Ethics 2 32 2 - General Education 52.0 824 19 7 7 5 4 4 4 4 4 4 10 Human Anatomy 8 80 96 6 6 + 11 Medical Biology 3 32 32 4 + 12 Histology and Embrology 5 64 32 5 + 13 Biochemistry and Molecular 7 80 64 9 + Chemistry 14 Genetics 2.5 32 16 3 + 15 Physiology 7 80 64 8 + Compulsory 16 Immunology 3.5 48 16 4 + 17 Pathology 7 80 64 9 + 18 Medical Parasitology 3 40 16 3 + 19 Pathophysiology 4 48 32 6 + 20 Microbiology 5 64 32 6 + 21 Pharmacology 6.5 80 48 9 + Basic Medicine 61.5 728 512 6 15 20 22 6 9 22 Regional Anatomy 3 24 48 5 + 23 Public Health 3 48 3 + 24 Medical Statistics 2 32 2 + 25 Epidemiology 2 32 2 + 26 Diagnostics 6.5 78 48 8 + 27 Chinese Medicine 3 52 12 4 + 28 Cardiography 1 14 12 2 + 29 Medical Imaging 3.5 48 16 4 + 30 Surgery 1 5 52 52 7 + 31 Anesthesia 0 24 2 + 32 Nuclear Medicine 2 32 2 + 33 Community Medicine 1.5 24 2 + 34 Forensics 2 32 2 + 35 Surgery 2 6 80 32 8 + Medicine 1 36 6 84 24 7 + Compulsory 37 Gynaecology 5 64 32 5 + 38 Oral Science 1.5 24 2 + 39 Medicine 2 4 52 24 5 + 40 Neurology and Psychiatry 2. 5 40 12 3 + 41 Pediatriacs 5 64 24 6 + 42 Opthalmology 2.5 32 16 3 + 43 Infectious Diseases 2.5 32 16 3 + 44 Dermatology 2.5 32 16 3 + 45 Ear Nose Thoat Surgery 2.5 32 16 3 + 46 ICU 2 32 3 + 47 Oncology 2 32 16 3 + Summary of Medicine I(Internal 48 Medicine ) 5 32 16 6 + Summary of Medicine 49 II(Surgery) 5 32 16 6 + Clinical Medicine 86 1156 448 0 12 14 17 24 23 49 Clinical Technique Training 4 32 64 8 + 50 Clinical Practice 48 1440 √ √ + 51 Clinical Technique Examination 0.5 √ + Compulsory 52 Graduation Examination 1 0.5 √ + 53 Graduation Examination 2 0.5 √ + Practice 53.5 1472 64 8 Total 253.0 4180.0 1024.0 25.0 22.0 27.0 27.0 22.0 27.0 21.0 28.0 27.0 12.0 Total class hours and the course 5204.0 4 4+1 4+1 5+1 4+1 7.0 6 6 7 5 number of each semester 2

MBBS Curriculum for 2011 Grade

Course Hour Weekly distribution per semister 1st 2nd 3rd 4th 5th 6th Number Course Credit Exam Course Nature Theory Laboratory 2 3 2 3 2 3 2 3 2 3 2 3 1 Chinese 23 368 11 5 5 3 + 2 Medical Chinese 8 128 4 4 4 4 + 3 Medical communication 5 80 4 4 + Compulsory 4 General Situation of China 4 64 4 + 5 Basic Information Technology 4 64 4 + 6 Medical History 2 32 2 - 7 Medical Sociology 2 32 2 - Elective 8 Medical Ethics 2 32 2 - 9 Psychology 2 24 12 2 - General Education 52.0 824 19 7 7 5 4 4 4 4 4 4 10 Medical Biology 3 32 32 4 4 + 11 Human Anatomy 8 80 96 12 12 Histology and Embrology 5 64 32 5 + 13 Biochemistry and Molecular 7 80 64 9 + Chemistry 14 Genetics 2.5 32 16 3 + 15 Physiology 7 80 64 8 + 16 Immunology 3.5 48 16 4 + Compulsory 17 Medical Parasitology 3 40 16 3 + 18 Pathophysiology 4 48 32 6 + 19 Pathology 7 80 64 9 + 20 Microbiology 5 64 32 6 + 21 Regional Anatomy 3 24 48 5 22 Pharmacology 6.5 80 48 9 + Basic Medicine 64.5 752 560 4 21 20 13 20 9 23 Public Health 3 48 3 + 24 Medical Statistics 2 32 16 2 + 25 Epidemiology 2 32 2 + 26 Diagnostics 6.5 78 48 8 + 27 Chinese Medicine 3 52 24 4 + 28 Cardiography 1 14 12 2 + 29 Medical Imaging 3.5 48 16 4 + 30 Surgery 1 5 52 52 7 + 31 Anesthesia 0 24 2 + 32 Nuclear Medicine 2 32 2 + 33 Community Medicine 1.5 24 2 + 34 Forensics 2 32 2 + 35 Surgery 2 6 80 32 8 + 36 Medicine 1 6 84 24 7 + Compulsory 37 Gynaecology 5 64 32 5 + 38 Oral Science 1.5 24 2 + 39 Medicine 2 4 52 24 5 + 40 Neurology and Psychiatry 2. 5 40 12 3 + 41 Pediatriacs 5 64 24 6 + 42 Opthalmology 2.5 32 16 3 + 43 Infectious Diseases 2.5 32 16 3 + 44 Dermatology 2.5 32 16 3 + 45 Ear Nose Thoat Surgery 2.5 32 16 3 + 46 ICU 2 32 16 3 + 47 Oncology 2 32 16 3 + Summary of Medicine I(Internal 48 5 32 16 6 + Medicine ) 49 Summary of Medicine II(Surgery) 5 32 16 6 + Clinical Medicine 157 1988 1100 18 27 32 17 24 23 49 Clinical Technique Training 4 32 64 8 + 50 Clinical Practice 48 1440 √ √ + 51 Clinical Technique Examination 0.5 √ + Compulsory 52 Graduation Examination 1 0.5 √ + 53 Graduation Examination 2 0.5 √ + Practice 53.5 1472 64 8 Total 327.0 5036.0 1724.0 23.0 28.0 27.0 36.0 51.0 45.0 21.0 28.0 27.0 12.0 Total class hours and the course 6760.0 4 4+1 4+1 5+1 4+1 7.0 6 6 7 5 number of each semester 3

MBBS Curriculum for 2012 Grade

Course Hour weekly distribution per semister 1st 2nd 3rd 4th 5th 6th Course Number Course Credit Exam Theory Laboratory Nature 1 2 1 2 1 2 1 2 1 2 1 2 1 Chinese 23 368 11 5 5 3 + 2 Medical Chinese 8 128 4 4 4 4 + 3 Medical communication 5 80 4 4 + Compulsory 4 General Situation of China 4 64 4 + 5 Basic Information Technology 4 64 4 + 6 Medical History 2 32 2 - 7 Medical Sociology 2 32 2 - Elective 8 Medical Ethics 2 32 2 - 9 Psychology 2 24 12 2 - General Education 52.0 824 19 7 7 5 4 4 4 4 4 4 10 Medical Biology 3 32 32 4 4 + 11 Human Anatomy 8 80 96 12 12 Histology and Embrology 5 64 32 5 + 13 Biochemistry and Molecular 7 80 64 9 + Chemistry 14 Genetics 2.5 32 16 3 + 15 Physiology 7 80 64 8 + 16 Immunology 3.5 48 16 4 + Compulsory 17 Medical Parasitology 3 40 16 3 + 18 Pathophysiology 4 48 32 6 + 19 Pathology 7 80 64 9 + 20 Microbiology 5 64 32 6 + 21 Regional Anatomy 3 24 48 5 22 Pharmacology 6.5 80 48 9 + Basic Medicine 64.5 752 560 4 21 20 13 20 9 23 Public Health 3 48 3 + 24 Medical Statistics 2 32 16 2 + 25 Epidemiology 2 32 2 + 26 Diagnostics 6.5 78 48 8 + 27 Chinese Medicine 3 52 24 4 + 28 Cardiography 1 14 12 2 + 29 Medical Imaging 3.5 48 16 4 + 30 Surgery 1 5 52 52 7 + 31 Anesthesia 0 24 2 + 32 Nuclear Medicine 2 32 2 + 33 Community Medicine 1.5 24 2 + 34 Forensics 2 32 2 + 35 Surgery 2 6 80 32 8 + 36 Medicine 1 6 84 24 7 + Compulsory 37 Gynaecology 5 64 32 5 + 38 Oral Science 1.5 24 2 + 39 Medicine 2 4 52 24 5 + 40 Neurology and Psychiatry 2. 5 40 12 3 + 41 Pediatriacs 5 64 24 6 + 42 Opthalmology 2.5 32 16 3 + 43 Infectious Diseases 2.5 32 16 3 + 44 Dermatology 2.5 32 16 3 + 45 Ear Nose Thoat Surgery 2.5 32 16 3 + 46 ICU 2 32 16 3 + 47 Oncology 2 32 16 3 + Summary of Medicine I(Internal 48 5 32 16 6 + Medicine ) Summary of Medicine II(Surgery) 49 5 32 16 6 + Clinical Medicine 152 1956 1084 18 27 32 17 24 23 49 Clinical Technique Training 4 32 64 8 + 50 Clinical Practice 48 1440 √ √ + 51 Clinical Technique Examination 0.5 √ + Compulsory 52 Graduation Examination 1 0.5 √ + 53 Graduation Examination 2 0.5 √ + Practice 53.5 1472 64 8 Total 322.0 5004.0 1708.0 23.0 28.0 27.0 36.0 51.0 45.0 21.0 28.0 27.0 12.0 Total class hours and the course 6712.0 4 4+1 4+1 5+1 4+1 7.0 6 6 7 5 number of each semester 4

Medical Biology

Credits: 3 Total hours: 64 Lectures hours: 32 Experiment Hours 32 Grade: 1st Semester: 1-2 Hui Li, Guang-Ming Gan Compilers: Ze-Hui Hong Email: [email protected]

Preface Medical biology is the study of life and the foundation of all scientific principles. This course is mandatory for all medical students who are pursuing a degree in medicine; in class, everything that is taught is fundamental in regards to the future profession in the medical field. Through class interactions, students will learn the structure and function of organisms at different levels such as molecular and cellular level and finally comprehend the organisms. The purpose of this class is for all students to learn medical biology and utilize it to the maximum in an effort to expand their knowledge of biological theories such as building blocks of DNA, Mendel’s theory of genetic crossing, and evolution. Meanwhile, we shall consider the requirements of different majors in medicine and correlate the teaching information with them. During the course, new research findings will be introduced for contents regarding cellular and molecular biology. In this way, we wish our students can grasp the important concepts and theories taught in this field. At the same time, we also want our students to keep in touch with new researches, new concepts and new theory system in the biological field. The teaching methods used in this course include lecture, lab experiments, self-study and videos. Medical biology is also an experimental course because all the basic theories in this class are based on experiments. Thus, lab experiments are a very important part of this course. We have designed 8 lab experiments in the course in order to help students understand the related knowledge, and to train their good ability of practice. Students should do the preview and review during the semester, which will help them comprehensively grasp all the knowledge and finally, know this field.

Ⅰ. Preamble and Objectives： This course is mandatory for all medical students who are pursuing a degree in medicine; in class, everything that is taught is fundamental in regards to the future profession in the medical field. Through class interactions, students will learn the structure and function of organisms at different levels such as molecular and cellular level and finally comprehend the organisms. The purpose of this class is for all students to learn medical biology and utilize it to the maximum in an effort to expand their knowledge of biological theories such as building blocks of DNA, Mendel’s theory of genetic crossing, and evolution. During the course, new research findings will be introduced for contents regarding cellular and molecular biology. In this way, we wish our students can grasp the important concepts and theories taught in this field. At the same time, we also want our students to keep in touch with new researches, new concepts and new theory system in biological field.

Ⅱ. Contents and Requirements： Chapter 1. Introduction To master Some basic concepts in medical biology. To be familiar with 1. What is biology and medical biology? 2. The main branches and the research methods in medical biology; 3. The relationship between medical biology, cell neology and life science. To understand 1. The current situation in medical biology and life science; 2. The newest research findings in this field.

Chapter 2. Cell Membrane and Cell Surface To master 1. Components of biomembrane 2. Structure of biomembrane: The fluid-mosaic model 3. Transmembrane transport 4. Membrane fluidity and membrane asymmetry 5. Differences among simple diffusion, facilitated diffusion, active transport and co-transport. 6

To be familiar with 1. Differences among phospholipids, sphingolipids and cholesterol. 2. Amphipathic lipids in biomembrane 3. Function of membrane proteins 4. The common features of both eukaryotic cell and prokaryotic cells. To understand 1. Function of plasma membrane 2. Membrane asymmetry 3. The nature of membrane fluidity

Chapter 3. Intracellular Compartments and Protein Transport To master 1. The concept of Endomembrane System 2. The two different types of organelles according to whether the organelles are surrounded by membrane or not. 3. Which organelles are membrane-enclosed organelles, and which are non-membrane-enclosed organelles? 4. The characteristics of two different types of ER. 5. The main functions of rER and sER 6. The main function of Golgi complex 7. The concept of the subtype of lysosome 8. The characteristics of lysosomes 9. The composition and function of ribosome 10. The three mechanisms by which proteins are imported into organelles 11. The concept of signal peptides and signal patches 12. The structure of the Mitochondria To be familiar with 1. The ways of protein modification after they are synthesized 2. The substances exchanged between cells and surrounding environment 3. The composition of cytoplasm matrix 4. The contents of signal hypothesis 5. The ways of protein modification after they are synthesized 7

6. The main functions of mitochondria To understand 1. The relationship between the different organelles and human diseases 2. The relationship between mitochondria and human disease 3. The whole process by which proteins are produced, modified and transported within the cells 4. The mechanisms by which the different proteins are marked, different signals and the ways they are directed into destinations.

Chapter 4. Cell Nucleus and Chromosomes To master 1. The functions of cell nucleus 2. The main parts of the cell nucleus 3. The structure and function of the nuclear envelope 4. The main composition and function of cell nucleolus 5. The concept of chromosome and chromatin. 6. The composition and structure of chromosomes 7. The basic unit of chromatin. 8. The composition of the nucleosome. 9. Chromosomes have four different levels of DNA packing. 10. How does the longer DNA molecular pack into the chromatin? 11. The characteristics of euchromatin and heterochromatin To be familiar with 1. The process of importing proteins and RNAs from the cytoplasm into the nucleus or vice versa. 2. The main functions of chromosomes 3. Metaphase chromosome structure To understand 1. Why compaction of DNA into chromosome is essential? 2. The biogenesis of rRNA 3. The assembling process of ribosome in cell nucleus

Chapter 5. Cytoskeleton and Cell Mobility 8

To master 1. Three types of cytoskeletal filaments 2. Describe the main functions of cytoskeleton 3. The 3 different types of microtubules, their names and structures 4. How to assemble microtubules 5. The “9+2” arrangement of microtubules in cilium or flagellum 6. The basic unit of the actin filament 7. How to assemble the actin filament 8. The basic unit of the IFs 9. How to assemble the IFs 10. The relationship between the nuclear lamina and IFs To be familiar with 1. The relationship between the cytoskeleton and cell mobility 2. The drugs specific to the three cytoskeletal filaments 3. The movements of cilium and flagellum To understand 1. The mechanism of cilium and flagellum’s movements 2. The structure of basal body 3. The structure of MTOC 4. The functions of motor proteins

Chapter 6. Cell-Cycle and Cell Division To master 1. What is the cell cycle 2. Cell Cycle Checkpoints 3. Mitosis 4. Meiosis 5. Restriction point 6. START 7. G1/S checkpoint 8. G2/M checkpoint 9. M checkpoint 9

10. G1 phase. 11. S phase. 12. G2 phase 13. Prophase. 14. Prometaphase. 15. Metaphase 16. Anaphase 17. Telophase 18. Cytokinesis 19. Unattached microtubules 20. Kinetochore microtubules 21. Polar microtubules 22. Anaphase A 23. Anaphase B To be familiar with 1. Three types of microtubules of the metaphase spindle 2. ProphaseⅠ 3. How do chromosomes move into the center of the cell 4. How do the microtubules become long or short To understand 1. How to prove that cell cycle is regulated by internal signals 2. cyclin 3. P53 4. MPF 5. M-cyclin 6. G1-cyclin

Chapter 7. Cell Differentiation To master 1. What is cell differentiation 2. What makes cells differentiate 3. Cell determination 10

4. Cell division and cell differentiation in the fertilized ovum 5. Totipotent cell 6. Pluripotent cell 7. Multipotent cell 8. Terminal differentiated cell 9. Trans-differentiation 10. Stem cell 11. ES cell 12. Adult Stem Cell 13. Extracellular factors To be familiar with 1. What is Parkinson’s disease? Do you have an idea to cure Parkinson’s disease? 2. Design an experiment to prove cell differentiation 3. Design an experiment to clone the calf 4. Which animals were cloned 5. Which is the first cloned animal? How was it cloned? To understand 1. Cell differentiation occurs through changes in gene expression 2. MyoD induces muscle differentiation 3. Extracellular Signals for Differentiation 4. Wnt pathway

Chapter 8. Cancer cell To master 1. Cancer cell 2. The characteristics of cancer cell To be familiar with 1. tumor suppressor gene 2. The P53 gene leads to tumor To understand The causes of cancer

Ⅲ. Practice Requirements As a basic course for medical students, medical biology also includes a number of experiment classes. In this way, the students can correlate theories with life phenomena. Upon completion of this course, the students will learn: 1. How to use the light microscope 2. How to draw biological maps 3. How to apply the basic theories in our life 4. Explain some life phenomena with the medical biology knowledge 5. Have the scientific attitude 6. Have the ability to design and carry out some basic experiments in this field

Ⅳ. Ability Training Requirements Upon completion of this subject, students will be able to acquire: 1. Critical thinking and reasoning abilities: By studying this course, the students can do reasonable analyses and judgments for common biological phenomena. 2. The training of experimental abilities: By studying this course, the students can grasp the basic experiment skills and cultivate their practical ability. In addition, their logical analysis ability will be improved by analyzing the experimental results and data. 3. Self-learning abilities: Since some chapters will not be taught in class, the students have the chance to collect the necessary information after class. In this way, the students’ self-learning abilities can be cultivated. 4. Expression abilities: The students must learn to express their thoughts and solutions to some questions. Some quizzes and coursework are the necessary methods to achieve this. 5. Innovation abilities: By studying this course, the students can practice their independent thinking and problem-solving ability. They will learn the methods of giving reasonable explanations to related life phenomena and design simple experiments to test them.

Ⅴ. Hours Distribution

Content Lecture Lab Clinical Clerkship 32 32 Introduction / Characteristics and Origin of Life 4 Cell Membrane and Cell Surface 4 Intracellular Compartments and Protein Transport 4 Cell Nucleus and Chromosomes 4 Cytoskeleton and Cell Mobility 4 Cell-Cycle and Cell Division 4 Cell Differentiation 4 Cancer cell 4

Ⅵ. Assessment

Coursework 5% Attendance and Performance 10% Quizzes 5% Lab Experiment 10% Mid-Exam 35% Final Exam 35% Total 100%

Ⅶ. Textbook and References Text Book Cell Biology, Shen Daling and Wu Chaoqun, Fudan Pub, 2006 Reference Books 1. Alberts B, et al. Molecular Biology of the Cell, 3rd. Garland Pub, Inc, 1995 2. Neil A.Campbell and Jane B.Reece. Essential Biology. Pearson Education Pub, 2001 3. Alberts B, Bray D and Hopkin K, et al. Essential Cell Biology. 2nd. New York and Lendon: Garland Science, 2004 4. Charlotte JA. Basic Cell Biology. Boston: Willard Grant Press, 1986

5. Lodish H, Berk A, Matsudaira P, et al. Molecular Cell Biology. 5th ed. New York: WH Freeman and Company, 2000 6. Qu Z, Wang X, Ding M. Cell Biology. Beijing: Higher Education Press, 2000 Journals 1. Guo M, Hay BA. Cell proliferation and apoptosis. Curr Opin Cell Biol, 1999, 11: 745-752 2. Beck S, Olek A, Walter J. From genomics to epigenomics. J Cell Sci, 2004, 117: 4355-4363 3. Robert SB, Shino N, Toren F. Mitochondria, oxidants, and senescence. Cell, 2005, 120 (4): 483-495 4. Peterson CL. Chromatin remodeling enzymes: taming the machines. EMBO Reports, 2002, 3(4): 319-322 5. Patrick FC, David CS, Joanna E, et al. Accumulation of mitochondrial DNA mutations in ageing, cancer, and mitochondrial disease: is there a common mechanism? Lancet, 2002, 360 (9342): 1323-1325 6. Paolo SC. Unique Chromatin remodeling and transcriptional regulation in spermatogenesis. Science, 2002, 296 (5576): 2176-2178 7. Jordan JD, Landau EM. Signaling networks: the origins review of cellular multitasking. Cell, 2000, 103: 193-200 Useful web sites 1. http://www.ncbi.nlm.nih.gov/ 2. http://www.bioon.com 3. http://bioinf.bmi.ac.cn/postnuke 4. http://www.bioon.com/bioengineering/moletech.htm 5. http://www.freemedicaljournals.com/: 6. http://61.183.18.11/freeweb.htm 7. http://cmbi.bjmu.edu.cn/ 8. http://www.ispub.com/ostia/index.php?xmlFilePath=ejournals.xml

Human Anatomy

Credits: 8 Total hours: 176 Lectures hours: 80 Experiment Hours 96 Grade: 1st Semester: 2 Hai-Qin Lv Compiler: Email: [email protected]

Ⅰ. Preamble and Objectives： Human Anatomy is the science of the structure and function of the human body and relations of its various parts. The discipline of anatomy is usually studied in a dual approach: Regional approach - description of structures regionally and their relationships to each other (back, thorax, abdomen, pelvis, perineum, neck, head, upper limb, lower limb); Systemic approach - description of the major systems of the body – musculoskeletal, nervous, cardiovascular, lymphatic, digestive, respiratory, endocrine, urinary and reproductive. Anatomy is one of the foundation subjects in medical study. Anatomical knowledge remains one of the cornerstones of modern medical practice and for healthcare and allied professions including, dentistry and dental care professions, physiotherapy, radiography and human communication sciences. Success in anatomy comes from knowing the terminology, the three-dimensional visualization of the structure(s) and using that knowledge in solving problems. The Human Anatomy course (course 4102101) is organized around a systemic approach to anatomy. The main task of this subject is that students will know the shapes and structures, the arrangements and relationships, the law of development and basic functions of the organs in human body.

Ⅱ.Teaching and Learning Requirements The teaching of Human Anatomy should be guided by the view of evolutionary development, should carry out the principle of combining theory with practice, shape with function, partly with whole. The teaching of systemic anatomy includes theory lectures and lab study. Theory lectures introduce the composition of the systems in human body, and introduce the basic structures, constructional features,

position, relationship of the organs and their function by multimedia. With experiments guided by the teachers during the lab time, the students should achieve the aim of strengthening the mastery of the elementary knowledge and basic skill of systemic anatomy by self-study, observation of the anatomic specimen and models, and the observation and touch of the living body of themselves. For the convenience of students studying the curriculum, the main contents of the systemic anatomy are arbitrarily divided into three kinds: “master”, “be familiar with” and “understand”, each of which has different requirements for students. For “master”- contents are the most essential and the most important components，and students must be able to precisely memorize this category of contents and correctly paraphrase them. The “be familiar with”- contents are the main contents，and students must know this second kind of contents. The “understand”-contents belong to general/common contents，and students only need to recognize and comprehend them.

Ⅲ. Contents and Requirements： Introduction To master 1. The definition of human anatomy 2. The descriptive anatomical terms: anatomical position, terms of direction, axes and planes of human body To be familiar with 1. Regions and systems of human body.

SECTION Ⅰ. LOCOMOTOR SYSTEM Chapter 1. Osteology To master 1. The shape, functions, classification and structure of bones; bone marrow. 2. General features of the vertebrae and main characteristics of the vertebrae in each region; the 3. intervertebral foramina and sacral hiatus. 4. The shape and parts of the sternum; clinical significance of the sternal angle. 5. Important structures in the internal surface of the base of the skull, lateral and anterior view of 6. the skull; pterion. 7. Names and location of the paranasal sinuses and their openings. 8. The morphology and main structures of the scapula and the hip bone. 16

To be familiar with 1. General features and structures of ribs; costal arch. 2. Important structures in the external surface of the base of the skull. 3. The composition of the orbit and the bony nasal cavity. 4. Features of the skull at birth and its changes after birth; cranial fontanelles. 5. The position and shape of the clavicle. 6. The position and arrangement of the carpal and tarsal bones. 7. The structure of the humerus, radius, ulna, femur, tibia and fibula; the sulcus for the radial nerve. 8. Important bony landmarks (the 7th cervical spinous process, the carotid tubercle, the sacral cornu, the jugular notch, the sternal angle and the xiphoid process). To understand 1. The composition and function of the locomotor system. 2. The chemical composition and physical properties of bones. 3. The bones of the trunk and the skull. 4. The position of the cerebral bones and the facial bones. 5. Groups of the bones of hand and foot, the shape and structure of each bone.

Chapter 2. Arthrology To master 1. Essential structures of a synovial joint; accessory structures of synovial joints; articular cavity and articular capsule. 2. The morphology, structure, function and clinical significance of intervertebral discs. 3. The location and function of the ligamenta flava. 4. The composition, constructional features and movements of the shoulder joint, elbow joint, hip joint and knee joint. 5. The formation, morphology and structure of the pelvis; the boundaries of the inlet and outlet of the true pelvis; the boundary line. To be familiar with 1. Types of movements at synovial joints. 2. The morphological and functional features of the vertebral column as a whole, the movements and physiological curves of the vertebral column. 17

3. The location and functions of the anterior longitudinal ligament and posterior longitudinal ligament. 4. The composition, shape and function of the thoracic cage. 5. The composition, structural features and movements of the temporomandibular joint, radiocarpal joint and talocrural joint (ankle joint). To understand 1. The concept of arthrology, the classification of joints; the kinds of synovial joints. 2. The movements of the thoracic cage 3. The articulations of the skull. 4. The formation, movements and functional significance of the carpometacarpal joint of thumb. 5. The composition, movements and functional significance of radioulnar joints. 6. The morphology, composition and functional significance of the arches of foot. 7. The features and significance of the pubic symphysis.

Chapter 3. Myology To master 1. Names, location and functions of the masticatory muscles. 2. The origin, insertion and function of the sternocleidomastoid. 3. The formation of the scalene fissure and the structures that pass through the scalene fissure. 4. The position and functions of the trapezius, latissimus dorsi, erector spinae, pectoralis major, serratus anterior and intercostal muscles. 5. The location, morphous, parts, structural features (the three openings and the central tendon) and function of the diaphragm; the structures that pass through the openings of the diaphragm. 6. The origin, insertion, location and function of the deltoid muscle, biceps brachii, triceps brachii, quadriceps femoris, sartorius, biceps femoris and triceps surae. To be familiar with 1. The morphology and structure of skeletal muscles. 2. The layers and function of the muscles of the anterolateral abdominal wall. 3. The composition, contents and clinical significance of the inguinal canal. 4. The sheath of the rectus abdominis; the inguinal ligament. 5. The composition and clinical significance of Hesselbach triangle; the femoral triangle. 18

6. Names and functions of the muscles of the arm, forearm, thigh and leg. 7. The location and function of the gluteus maximus, iliopsoas and piriformis. To understand 1. The classification and nomenclature of muscles, muscle attachments (the origin and the insertion); the supplementary structures of muscles. 2. The composition muscles of head; names, the distribution and function of the facial muscles. 3. The position and function of the suprahyoid and infrahyoid muscles. 4. Names and main functions of the muscles of the shoulder; groups, position and functions of muscles of the hand; the concept of thenar. 5. The composition of the axilla, triangular space, quadrangular space, fossa cubitalis and carpal canal; and the main structures that pass through them. 6. The composition of the adductor canal and popliteal fossa, and the main structures that pass through them.

SECTION II. SPLANCHNOLOGY Chapter 4. General Description of Splanchnology To be familiar with 1. The reference lines of thorax and abdominal regions; the abdominal regions. To understand 1. The concept of splanchnology, 2. General structures and morphology of viscera.

Chapter 5. Alimentary System To master 1. The concepts of the supradigestive tube and infradigestive tube. 2. The composition of the isthmus of fauces. 3. The shape and position of the major salivary glands, the openings of their glandular tubes. 4. The location and parts of the pharynx, the main structures and communication of each part. 5. The location and morphology of the esophagus; the location (includes the distance from the central incisor) and significance of the three narrowed places of the esophagus. 6. The shape, parts and position of the stomach. 7. The location of the vermiform appendix, the common surface marking for the base of 19

appendix (McBurney’s point). 8. The shape and position of the liver; the composition of the external biliary tracts of liver. 9. The position where the common bile duct and the pancreatic duct unite into the hepatopancreatic ampulla, the opening of the ampulla, the biliary discharge way. 10. The Calot's triangle, the hepatopancreatic ampulla (the Vater’s ampulla), the sphincter of hepatopancreatic ampulla (the sphincter of Oddi). To be familiar with 1. The parts of the oral cavity and its boundaries. 2. The appearance of the tongue, the features of the mucosa of tongue (the papillae of the tongue). 3. The origin, insertion and function of the genioglossus. 4. The shape and structure of teeth, the dental formula of the permanent teeth and the deciduous teeth. 5. The location, parts and morphological characteristics of the duodenum. 6. Parts of the large intestine, the location and morphological characteristics of the colon. 7. The location and structural features of the cecum. 8. The location, morphology and structure of the rectum and anal canal; the dentate line. 9. The shape, position and divisions of the gallbladder. 10. The surface projection of the liver. 11. The position and divisions of the pancreas. To understand 1. The composition and function of the digestive system. 2. The composition and function of the periodontium. 3. The composition of the tonsilar ring. 4. The structure of the wall of the esophagus and stomach; relations of the stomach. 5. The location and morphology of the ileum and jejunum, the structural differences between the ileum and jejunum. 6. The concept of segmentation of liver, segments of liver.

Chapter 6. Respiratory System To master 1. The concepts of the upper respiratory tract and the lower respiratory tract. 20

2. Names, position and openings of the paranasal sinuses. 3. The laryngeal cartilages; the morphology and structure of the laryngeal cavity; the conus elasticus and the vocal fold. 4. The shape, position and lobes of the lungs; the root of lung. 5. The concepts of the pleura and pleural cavity 6. Parts of the parietal pleura and the location of the pleural recesses; the costodiaphragmatic recess. To be familiar with 1. Parts of the nasal cavity, the morphology and structure of each part; Little region or Kiesselbach region. 2. The location and the main surface marks of the larynx. 3. The location and constructional features of the trachea; the carina of trachea. 4. The morphological differences between the left and right principal bronchi. 5. The projection of the lungs and pleurae. 6. The concept of the pulmonary segment or bronchopulmonary segment, the segments of lungs; the pulmonary ligament. 7. The concept of the mediastinum. To understand 1. The composition and function of the respiratory system. 2. The structural features of the respiratory tract. 3. The shape and structure of the external nose. 4. Laryngeal joints, the location and functions of the muscles of larynx. 5. The differences between the lungs of fetus and adult. 6. The divisions of the mediastinum and the main structures of each division.

Chapter 7. Urinary System To master 1. The position, shape, structure and capsules of kidney. 2. The renal hilum, renal pedicle, renal region and renal sinus. 3. The shape, parts and narrows of ureter. 4. The features and location of the urinary bladder, the trigone of bladder.

To be familiar with 1. The composition and functions of the urinary system. 2. The relations of kidneys, the concept of renal segment, the segments of kidneys. 3. The relations of the pelvic part of ureters of the female; the interureteric fold. 4. The morphological features and openings of the male and female urethrae. To understand 1. The malformation and abnormality of kidney. 2. The anatomical basis of kidney transplant.

Chapter 8. Male Reproductive System To master 3. The shape and location of the testis and epididymis. 4. The morphological features, parts and course of ductus deferens. 5. The composition and parts of the spermatic cord. 6. Parts of the male urethra and its structural features (two curvatures, three dilations, three narrows) To be familiar with 1. The composition and function of the male reproductive system. 2. The structures of the testis and epididymis. 3. The shape and location of the seminal vesicle. 4. The shape, position, lobes and main relations of the prostate. 5. The formation, course and opening of the ejaculatory duct. 6. The structure of the penis and the features of its skin. To understand 1. The composition and function of the reproductive system. 2. The shape and structure of the scrotum. 3. The position of the bulbourethral glands and their openings.

Chapter 9. Female Reproductive System To master 1. The shape and position of the ovary and its supports；the suspensory ligament of ovary. 2. The position, parts, morphological features and clinical application of the uterine tube; the 22

isthmus of uterine tube. 3. The shape, parts, position and supports of the uterus; the isthmus of uterus. 4. The morphology and position of the vagina; the composition and relations of the fornix of vagina. To be familiar with 1. The position of the vaginal orifice and the external orifice of the urethra within the vaginal vestibule. 2. The composition and functions of the female reproductive system; the concept of the perineum. 3. The shape and structural features of the breast; the suspensory ligament of breast (Cooper’s ligament). 4. The concepts of the pelvic diaphragm and the urogenital diaphragm, and the structures that pass through them. To understand 1. Ovarian and uterine changes with age. 2. The morphology and structure of the female external genital organs. 3. The position of female mammary glands. 4. The boundaries and divisions of the perineum

Chapter 10. Peritoneum To master 1. The concepts of the peritoneum and the peritoneal cavity; the function of the peritoneum. 2. The location and parts of the lesser omentum and the greater omentum; names of the mesenteries. 3. The location of the rectouterine pouch (Douglas pouch) and the rectovesical pouch. To be familiar with 1. The relationship between the abdominopelvic viscera and the peritoneum. 2. The names and location of the ligaments of liver and stomach. 3. The location of the hepatoduodenal ligament and the main structures that pass through it. 4. The location and connection of the omental bursa and the omental foramen. To understand 1. The composition and function of the greater omentum. 23

2. The position and attachments of mesenteries. 3. The composition of ligaments. 4. The position and connection of the hepatorenal recess.

SECTION III. CIRCULATORY SYSTEM Chapter 11. Cardiovascular System To master 1. The position and external features of the heart; the morphology and structures of the chambers of heart. 2. The composition, location and function of the conduction system of heart. 3. The origin, insertion and course of the right and left coronary arteries, and the distribution of their principal branches. 4. The concepts of the pericardium and pericardial cavity; the location and clinical significance of the transverse and oblique sinuses of pericardium. 5. The position and functions of the carotid glomus and carotid sinus. 6. The course and distribution of the main branches of the external carotid artery. 7. The composition of the superficial and deep palmar arches. 8. Main branches of the abdominal aorta. 9. The course and distribution of the celiac trunk, the superior and inferior mesenteric arteries and their branches. 10. The origin, course and distribution of the uterine artery. 11. The impulse points of arteries of the head, neck and extremity (the facial artery, superficial temporal artery, common carotid artery, subclavian artery, brachial artery, radial artery, femoral artery, and the dorsal artery of foot). 12. The course of the external jugular vein, cephalic vein, median cubital vein, basilic vein and the places where these veins drain into. 13. The origin, course and insertion of the azygos vein; the concept of the venous angle. 14. The origin, course, insertion and tributaries of the small saphenous vein and the great saphenous vein. 15. The composition, course, branches and tributaries of the hepatic portal vein; the anastomoses between the hepatic portal vein system and the vena caval system and the corresponding clinical significance. 24

To be familiar with 1. The composition of the circulatory and cardiovascular systems 2. The concepts of systemic circulation and pulmonary circulation. 3. The morphology and structures of the interatrial and interventricular septa, places where the septal defect often occurs. 4. The position of the coronary sinus and its opening. 5. The course of the pulmonary trunk, the right and left pulmonary arteries; the concept of arterial ligament. 6. The origin, termination, course and division of the aorta; the branches of the aortic arch (the brachiocephalic trunk, left common carotid artery and left subclavian artery). 7. The location, origin and course of the right and left common carotid arteries, right and left internal carotid arteries. 8. The origin, termination, course and distribution of the subclavian artery, axillary artery, brachial artery, radial artery, and ulnar artery. 9. The course and distribution of the posterior intercostal arteries, ovarian/testicular artery and renal artery. 10. The origin, termination and distribution of the common iliac artery, external iliac artery, femoral artery, popliteal artery, anterior and posterior tibial arteries, dorsal artery of foot. 11. The composition of the venous system; the structural features of veins; the features of the specific veins (the sinuses of dura mater, the diploic veins and emissary veins). 12. The composition, origin, course and insertion of the superior vena cava. 13. The composition and course of the brachiocephalic vein. 14. The origin, insertion, course and main tributaries of the internal jugular vein, subclavian vein and axillary vein; the communication between the intracranial and extracranial veins. 15. The origin, course and insertion of the inferior vena cava, common iliac vein, external iliac vein, internal iliac vein, femoral vein and popliteal vein. 16. The course of the renal veins, testicular vein/ovarian vein and the places where they drain into. To understand 1. The constructional features of arteries, blood capillaries and veins. 2. The concepts of vascular anastomosis and collateral circulation. 3. The course and drainage of the great, middle and small cardiac veins. 4. The structure of the heart walls and the surface projections of the margins of the heart. 25

5. The features of the distribution of the intestinal arteries. 6. The distribution of the remaining branches of the internal iliac artery. 7. The composition of the plantar artery arch. 8. The factors that affect the venous return. 9. The course of the right and left pulmonary veins. 10. The origin, course and insertion of the hemiazygos and accessory hemiazygos veins. 11. The position, communication and structural features of the veins of vertebral column. 12. The position of the pelvic venous plexuses. 13. The communication between the superior vena cava and the inferior vena cava.

Chapter 12. Lymphatic System To master 1. The synthesis and course of the thoracic duct; the place where it delivers the lymph to, and its collecting area; cisterna chili. 2. The composition of the right lymphatic duct; the place where it delivers the lymph to, and its collecting area. 3. The formation and collecting area of the jugular lymph trunk, subclavian lymph trunk, bronchomediastinal lymph trunk, lumbar lymph trunk and intestinal lymph trunk. Groups of the axillary lymph nodes, the distribution and collecting area of each group, and their clinic significance. 4. The shape and position of the spleen; splenic notch. To be familiar with 1. The composition of the lymphatic system; the structure and general pattern of, and lymphatic return of, the lymphatic system; regional lymph node. 2. The distribution and collecting area of the submandibular lymph nodes, submental lymph nodes, superficial and deep lateral cervical lymph nodes, and the places where their efferent lymphatic vessels drain to. 3. The location, collecting area and clinic significance of the bronchopulmonary lymph nodes. 4. The lymph drainage of the stomach and breast. 5. The distribution and collecting area of the superficial inguinal lymph nodes and deep inguinal lymph nodes.

To understand 1. The factors that affect the lymphatic return. 2. The location of the main groups of lymph nodes within the thoracic wall and thoracic cavity. 3. The distribution and collecting area of the external iliac lymph nodes, internal iliac lymph nodes and sacral lymph nodes. 4. The distribution and collecting area of the popliteal lymph nodes, lumbar lymph nodes, inferior mesenteric lymph nodes, superior mesenteric lymph nodes and celiac lymph nodes. 5. The lymph drainage of the esophagus, liver, rectum, lungs and uterus. 6. The shape and position of thymus.

SECTION IV. SENSORY ORGANS Chapter 13. General Description To be familiar with The concepts of receptor and sensory organs, the classification of sensory organs.

Chapter 14. Visual Organ To master 1. The shape, structure, divisions and function of the coats (tunics) of eyeball 2. The sinus venosus sclerae, iridocorneal angle, optic disc and macula lutea. 3. The shape and position of the lens and vitreous body. 4. The refractive media of the eye and the circulation of the aqueous humor; aqueous chamber. To be familiar with 1. The shape and parts of conjunctiva. 2. The composition of the lacrimal apparatus; the production of tears and the lacrimal passage. 3. Names, position and function of the extraocular muscles. To understand 1. The composition and function of the accessory organs of eye. 2. The shape and structure of the eyelids. 3. The adipose body of orbit and the fasciae of orbit. 4. The blood vessels and nerves of eye.

Chapter 15. Vestibulocochlear Organ To master 1. The location, morphology (the main structures of the six walls) and communication of the tympanic cavity. 2. The shape, features, opening and function of the auditory tube; the characteristics of the auditory tube in childhood. 3. The composition, morphology and structure of the bony labyrinth and membranous labyrinth. 4. The name and position of the receptors for the auditory sensation and the sensation of position; the spiral organ (organ of Corti), the crista ampullaris (ampullary crest). To be familiar with 1. The shape, location and parts of the tympanic membrane. 2. The location, morphology, and parts of the external acoustic meatus and characteristics of infant’s external acoustic meatus. 3. Names, articulation, position and function of the auditory ossicles. 4. The position of the mastoid antrum and mastoid cells. To understand 1. The composition of the external ear and the middle ear. 2. The composition of the vestibulocochlear organ, the function of each portion of the vestibulocochlear organ. 3. The morphology of the utricule, saccule, membranous semicircular canals and membranous cochlea. 4. The function of the tensor tympani and stapedius. 5. The ways of conduction of the sound waves.

SECTION V. NERVOUS SYSTEM Chapter 16. General Description To master 1. The divisions of the nervous system (NS). 2. The concepts of the gray matter, cortex, nucleus, ganglion. 3. The concepts of the white matter, medulla, fasciculus, nerve. To be familiar with 1. The concept of reflex; the basic components of a reflex arc. 28

2. The concept of reticular formation. To understand 1. The components of the nervous system (the structural features and classification of neurons). 2. The function and position of the nervous system in human body.

Chapter 17. Central Nervous System To master 1. The external features (the cervical and lumbosacral enlargements) of the spinal cord; the anatomic relationship between the segments of spinal cord and vertebral bodies. 2. The main nuclei of the anterior horn (column), posterior horn (column) and intermediate zone of the gray matter of spinal cord; the nature and functions of the main nuclei of spinal cord. 3. The position, origin, termination and functions of the fasciculus gracilis, fasciculus cuneatus and spinothalamic tract. 4. The position, origin, termination and functions of the corticospinal tract. 5. The location and function of the main cranial nuclei (Ⅲ, Ⅴ, Ⅵ, Ⅶ, Ⅹ, Ⅻ) 6. The location and function of the gracile nucleus and cuneate nucleus. 7. The fourth ventricle. 8. The location and function of the pyramidal tract, the decussation of pyramid，the medial lemniscus, the decussation of medial lemniscus , the spinal lemniscus, and the lemniscus trigeminalis in brain stem. 9. The lobes of the cerebral hemisphere; the main sulci/fissures and gyri on each surface of the cerebral hemisphere. 10. The location and function of the language areas (the motor speech area, writing area, auditory speech area, visual speech area); Broca’s area. 11. The composition and position of the basal nuclei; the concept of the corpus striatum. 12. The location and parts of the internal capsule; the fiber bundles that pass through each portion of the internal capsule; the clinical features of the lesion of the internal capsule. 13. The shape and subdivisions of the corpus callosum. To be familiar with 1. The position and segments of spinal cord; the level of the upper and lower ends of spinal cord. 2. The cauda equina and cervical enlargement. 3. The distribution and parts of the white matter and gray matter of spinal cord, the name of each 29

portion. 4. The position, origin, termination and function of the rubrospinal tract and the vestibulospinal tract. 5. The composition and external features of the brain stem; the rhomboid fossa and the crus cerebri. 6. The nature, classification and distribution pattern of the cranial nuclei in the brain stem. 7. The location and function of the superior colliculus, inferior colliculus, red nucleus, substantia nigra and pretectal area. 8. The formation and function of the lateral lemniscus; Trapezoid body. 9. The location and shape of the cerebellum; the three pairs of the cerebellar peduncles; the cerebellar tonsil. 10. The composition of the cerebellar nuclei. 11. The function of the cerebellum; typical manifestations of cerebellar injury. 12. The function of the ventral posterolateral nucleus and the ventral posteromedial nucleus. 13. The function of the medial geniculate body and lateral geniculate body. 14. The location, shape and subdivisions of the diencephalon; the third ventricle. 15. The fiber connections and function of the specific relaying nuclei of the dorsal thalamus. 16. The location and shape of the hypothalamus; the function of the main nuclei of the hypothalamus. 17. The shape and parts of the lateral ventricle; choroid plexus. 18. The concepts of the hippocampal formation, limbic system and limbic lobe. 19. The composition of the commissural fibers and projection fibers. To understand 1. The position of the central canal of spinal cord. 2. The concepts of the  motor neuron and  motor neuron of the anterior horn of spinal cord. 3. The Rexed's laminae of gray matter. 4. The function of the anterior spinocerebellar tract, posterior spinocerebellar tract, tectospinal tract, reticulospinal tract, and medial longitudinal fasciculus. 5. Spinal reflexes, the clinical manifestation when spinal cord is injured. 6. The position and parts of the brain. 7. The position, structural features, main nuclei, fiber connections and function of the reticular formation of the brainstem. 30

8. The structure of the main transverse sections of brainstem. 9. The typical clinical manifestations of the lesions of brainstem. 10. The lobes and divisions of the cerebellum; the fiber connections of the cerebellum. 11. The function and main fiber connections of the hypothalamus. 12. The position and main structures of the dorsal thalamus, epithalamus, subthalamus and hypothalamus.

Chapter 18. Peripheral Nervous System To master 1. The composition, course and distribution of the phrenic nerve. 2. The origin, course, main branches and distribution of the median nerve, ulnar nerve, radial nerve. 3. The location and distribution of the musculocutaneous nerve and the axillary nerve. 4. The main manifestation of the dysfunction in movement and sensation resulting from the lesion of the median nerve, ulnar nerve, radial nerve or axillary nerve. 5. The course and distribution of the anterior rami of thoracic nerves; the segmental distribution of the cutaneous branches of the anterior rami of thoracic nerves. 6. The composition, course, main branches and distribution of the femoral nerve. 7. The origin, course and distribution of the sciatic nerve. 8. The course, branches and distribution of the tibial nerve. 9. The course of the deep peroneal nerve and superficial peroneal nerve, the muscles that they innervate, and the distribution of their cutaneous branches. 10. The name, order, nature, distribution and classification of the cranial nerves; the position at which each cranial nerve links with the brain; the position at which the cranial nerves enter or leave the cranial cavity. 11. The functional components and course of the oculomotor nerve; the extraocular muscles innervated by the oculomotor nerve; the distribution and function of the parasympathetic fibers of oculomotor nerve. 12. The functional components of the trigeminal nerve; the position and nature of the trigeminal ganglion. 13. The course of the three major branches of the trigeminal nerve and their cutaneous distribution in the head. 31

14. The course and distribution of the abducent nerve. 15. The functional components and course of the facial nerve, the distribution of its main branches (the branches to facial muscle and chorda tympani). 16. The functional components and main branches of the vagus nerve, the course of the trunk of the vagus nerve. 17. The course and distribution of the trunk of the accessory nerve. 18. The distribution of the hypoglossal nerve. 19. Concepts of visceral nerves, preganglionic fibers and postganglionic fibers. 20. The position of the lower center of the sympathetic nervous system and the parasympathetic nervous system. 21. The composition and location of the sympathetic trunk; paravertebral ganglia; the location of the main prevertebral ganglia. 22. The composition, nature and distribution of the greater splanchnic nerve and lesser splanchnic nerve. 23. The origin of the parasympathetic preganglionic fibers of the oculomotor nerve, facial nerve and glossopharyngeal nerve; the places where these parasympathetic preganglionic fibers synapse with the postganglionic neurons; the distribution and function of their postganglionic fibers. 24. The main differences between the sympathetic nerve and the parasympathetic nerve. To be familiar with 1. The composition, parts, fibrous components and branches of spinal nerves; the anterior root and posterior root. 2. The position and composition of the cervical plexus; the distribution and clinical application of the cutaneous branches of the cervical plexus. 3. The composition, position and clinical application of the brachial plexus. 4. The position and distribution of the long thoracic nerve and thoracodorsal nerve. 5. The composition, position and main branches of the lumbar plexus and sacral plexus. 6. The main manifestation of the dysfunction in movement and sensation resulting from the lesion of the tibial nerve or common peroneal nerve. 7. The nature, course and function of the optic nerve; the distribution of the trochlear nerve. 8. The main branches of the ophthalmic nerve (the frontal nerve, lacrimal nerve and nasociliary nerve) and their distributions. 32

9. The course of the trunk and main branches of mandibular nerve; the distribution of the motor and sensory fibers of mandibular nerve. 10. The course, nature and function of the vestibulocochlear nerve. 11. The functional components of glossopharyngeal nerve; the distribution of the principal branches of the glossopharyngeal nerve. 12. The main clinical manifestation for the lesion of the hypoglossal nerve. 13. The location and distribution of the superior laryngeal nerve; the course and distribution of the right and left recurrent laryngeal nerves. 14. The main differences between the visceral motor nerves and the somatic motor nerves. 15. The concepts of communicating branch, white communicating branch/ramus and grey communicating branch/ramus. 16. The location of the superior cervical ganglion and its distribution of the postganglionic fibers. 17. The distribution of the postganglionic fibers in the pelvic cavity; the distribution of the pelvic splanchnic nerves. 18. The origin and distribution of the parasympathetic preganglionic fibers of the vagus nerve. 19. The concept of the visceral dual innervation. To understand 1. The general distribution of spinal nerves; the distributing characteristics and important relations of spinal nerves near the intervertebral foramina. 2. The general distribution of the suprascapular nerve, subscapular nerves, dorsal scapular nerve, medial brachial cutaneous nerve, medial antebrachial cutaneous nerve. 3. The course and distribution of the iliohypogastric nerve, ilioinguinal nerve, obturator nerve and lateral femoral cutaneous nerve. 4. The variation of the sciatic nerve. 5. The course, main branches and distribution of the pudendal nerve. 6. The nature and distribution of the olfactory nerve. 7. The location and nature of the ciliary ganglion, otic ganglion, submandibular ganglion and pterygopalatine ganglion. 8. The main clinical manifestations for the lesions of the oculomotor nerve, abducent nerve, trigeminal nerve and facial nerve. 9. The distribution and branches of the anterior and posterior trunks of the vagus nerve in the abdominal cavity. 33

10. The main clinical manifestations for the lesions of the vagus nerve and its principal branches (the right and left recurrent laryngeal nerves). 11. The divisions and distribution of visceral nerves; the three destinations of the preganglionic fibers and postganglionic fibers. 12. The position of the middle cervical ganglion and inferior cervical ganglion，their distribution of the postganglionic fibers. 13. The segmental distribution of the preganglionic fibers and postganglionic fibers of the sympathetic nerve. 14. The concept of visceral nervous plexus. 15. The concept and clinical significance of referred pain.

Chapter 19. Nervous Pathways To master 1. The composition of the conscious deep sensory (body posture, movement and vibration as well as two-point discrimination) pathway for trunk and limbs. 2. The composition of the superficial sensory pathway (the pain, temperature, coarse touch and pressure) for the trunk and limbs. 3. The composition of the superficial sensory pathway (the pain, temperature, touch and pressure) of the head and face. 4. The composition of the visual pathway; the composition of the pupillary light reflexes pathway. 5. The composition and course of the pyramidal system, the location of fibers decussating, and its connection with lower motor neurons. 6. The pyramidal tract and the corticonuclear tract. To be familiar with 1. The visual field defect when a lesion occurs at any point in the visual pathway. 2. The significance of the changes in pupillary light reflexes. 3. The composition of the auditory pathway. 4. The concepts of the upper motor neuron, the lower motor neuron, the supranuclear lesion, the infranuclear lesion and the extrapyramidal system. 5. The composition and function of the main pathways of the extrapyramidal system.

To understand 1. The composition of the unconscious deep sensory pathway for the trunk and limbs. 2. The composition of the equilibrator sensory pathway and visceral sensory pathway.

Chapter 20. Meninges and Blood Vessels of Brain and Spinal Cord, and Cerebrospinal Fluid To master 1. The location, features, contents and clinical application of the epidural space and the subarachhoid space. 2. The location, features, contents and clinical application of the subarachnoid space. 3. The position and communication of the cavernous sinus; the structures that pass through or are located adjacent to the cavernous sinus. 4. The course of the internal carotid artery, the vertebral artery and the basilar artery; and the distribution of their principal branches. 5. The position, composition and significance of the cerebral arterial circle (Circle of Willis). 6. The composition of the ventricular system; the production and circulation of the cerebrospinal fluid. To be familiar with 1. The morphological characteristics of the spinal dura mater, the spinal arachnoid mater and the spinal pia mater. 2. The source and distribution of the arteries of spinal cord. 3. The compositional features of the cerebral dura mater; the structures formed by the cerebral dura mater (cerebral falx, tentorium of cerebellum, tentorium incisure, diaphragma sellae, dural sinuses); dural sinuses. 4. The dysfunction of the body resulting from a lesion of the central branches of the middle cerebral artery. 5. The location, morphological features and significance of the subarachnoid cisterns, arachnoid granulations and denticulate ligaments. To understand 1. The position and communication of the other dural sinuses. 2. The main tributaries of the superficial cerebral veins and deep cerebral veins, and their returns. 3. The areas of spinal cord where vascular insults occur most commonly. 35

SECTION Ⅵ. ENDOCRINE SYSTEM Chapter 21. Endocrine System To understand 1. The composition, structural features and function of the endocrine system. 2. The shape and location of the hypophysis, thyroid gland, parathyroid gland, adrenal gland and pineal body.

Ⅳ. Ability Training Requirements Upon the successful completion of Human Anatomy, students will be able to: 1. Master the basic theory, elementary knowledge and basic skills of systemic anatomy. 2. Understand and use accepted anatomical language to describe the normal structure of the body. 3. Obtain the ability of self-studying and observing and integrating, and will also have gained the ability of using anatomical knowledge in analyzing, reasoning and solving problems.

Ⅴ. Hours Distribution Total teaching hours are176 with 80 hours spent on the theory lectures and 30 hours on the Lab studies.

Chapters Contents Lecture Lab Introduction Introduction 7 8 Chapter 1 Osteology Chapter 2 Arthrology 5 6 Chapter 3 Myology 6 7 Chapter 4 General Description of Splanchnology 6 7 Chapter 5 Alimentary System Chapter 6 Respiratory System 3 3 Chapter 7 Urinary System 1.5 2 Chapter 8 Male Reproductive System 1.5 2 Female Reproductive System, mamma, Chapter 9 2 2 perineum Chapter 10 Peritoneum 1 1 Chapter 11 Cardiovascular System 9 11 Chapter 12 Lymphatic System 2 2 Chapter 13 General Description of Sensory organs 2 3 Chapter 14 Visual Organ Chapter 15 Vestibulocochlear Organ 2 3 Chapter 16 General Description 12 14 Chapter 17 Central Nervous System Chapter 18 Peripheral Nervous System 12 14 Chapter 19 Nervous Pathway 5 9 Meninges and Blood Vessels of Brain and Chapter 20 3 3 Spinal Cord, and Cerebrospinal Fluid Chapter 21 Endocrine system Self-study Self-study

Ⅵ. Assessment

Lab (Quizzes) 40% Final Examination 60% Total 100%

One final written examination will be conducted after the completion of the subject. The students will be grouped during the lab time and the members of each group will be asked to cooperate with each other. Ten (10) quizzes will be given during the lab studies and the students of each group will be randomly chosen for the quiz each time. The points obtained by the chosen students will represent their group’s marks for a given quiz. For example, all the members of the group will get four (4) points for a given quiz if the chosen student gets four (4) points for that quiz; on the other hand, all the members of the group will get zero (0) if the chosen student is absent or gets zero (0) on the day of the quiz. The comprehensive score of a student is eventually determined by the synthetic evaluations of his /her marks obtained in the above quizzes and examinations. The total points obtained in the quizzes will make up 40% of the final comprehensive score and the points obtained in the final written examination will make up 60% of the final comprehensive score.

Ⅶ. Textbook and references Text Book: Shuling Bai, ed. 2007. Textbook of Human Anatomy, Beijing: People’s Medical Publishing House Reference Books: 1. Heinz Feneis and Wolfgang Dauber, eds. 2000. Pocket Atlas of Human Anatomy, 4th edition, New York: Thieme Stuttgart. 2. Van De Graaff, 2001. Human Anatomy, 6th Edition, Columbus: The McGraw−Hill Companies. 3. Adolf Faller, Michael Schünke and Gabriele Schünke, 2004. The Human Body: An Introduction to Structure and Function, New York: Thieme Stuttgart. 4. Richard L Drake, Wayne Vogl, and Adam WM Mitchell, eds. 2010. Gray’s Anatomy for Students, 2nd edition, London: Churchill Livingstone.

Histology and Embryology

Credits: 5 Total hours: 96 Lectures hours: 64 Experiment hours 32 Grade: 1st Semester: 2 Shao-Ping Huang Compiler: Email: [email protected]

Preface Histo-embryology (course 4102108) comprises two parts: Histology and Embryology. It is a subject to study the microstructures and the functions of the organs, and their relationship in the human body; and also to study the early developmental process of the embryo, which provides morphological knowledge for studying physiology, biochemistry, immunology and pathology, and is one of the basic subjects in medical study which is primarily designed for the preclinical medicine students.

Ⅰ. Preamble and Objectives The teaching purpose of Histology and Embryology is to induce the students to acquire the basic theories and knowledge of these two courses, which involves studying the microstructure under the light microscope and the ultra-structure under the electronic microscope of the human body, the relationship between the structures and their function, and the early development of human body. The objective is also to help the students to gain relative basic skill training and tolay a solid foundation for studying the other subsequent medical curriculums.

Ⅱ. Teaching and Learning Requirements The basic teaching requirements of Histology and Embryology for medical department of five-year system of medical college (majors such as preventative medicine, clinical medicine, nursing speciality, etc) have been given in this teaching syllabus. According to the teaching plan, the total teaching hour is 96h.The contents in this outline will be taught by lecture, practice, individual study and so on. The proportion of lectures to experiments of histology is 2:1. 39

The three-grade requirements of “to master”, “to be familiar with” and “to understand” have been pointed in the learning objectives of every chapter. The contents that are to “be mastered” are the important points that must be kept in mind and assimilated and that can be applied, those “to be familiar with” are the points one must grasp or comprehend. Also there is knowledge that is “to be understood”, which are the simple contents that are usually left for students to study by themselves. The contents of the three levels are interrelated with each other, so one must grasp the emphases in the process of learning. The teachers should always pay attention to the advancement of the two courses and make the teaching contents reflect the new advances of the subjects.

Ⅲ. Contents and Requirements Chapter 1. Introduction To master 1. The research contents and purpose of histology. 2. The composition of the tissue and its types. 3. The observation of histological sections stained by haematoxylin and eosin (HE). The meaning of the concepts of “high electron dense” and “low electron dense” of transmission electron micrograph. To be familiar with 1. The meaning of acidophilic, basophilic, neutrophilic, metachromasia, argentaffin and argyrophilia. 2. The concept and significance of histochemistry and immunohistochemistry. To understand 1. The situation of histology in medicine and its learning methods. 2. The progress and development trends of histology. 3. The basic principle of scanning electron microscope. 4. The method of tissue culture. 5. Other research technics of histology.

Chapter 2. Epithelial Tissue To master 1. The general features of the epithelial tissue. 2. The classification, structural features and functions of varieties of the covering epithelia. 40

3. The special structures of the epithelial cell: The microstructural and ultra-structural features and functions of microvilli on the free surface of the epithelial cell. The ultra-structural features and functions of varieties of intercellular junctions. The ultra-structural features and functions of basement membrane and plasma membrane infolding in the basal surface of the epithelial cells. To be familiar with 1. The structures of cilia on the free surface of the epithelial cell. 2. The concept of glandular cell, glandular epithelium and the gland. 3. The structures of the hemidesmosome. To understand The classification of the exocrine gland.

Chapter 3. Connective Tissue Proper To master 1. The origin, features and classification of the connective tissue. 2. The loose connective tissue: the structures and functions of various components of the loose connective tissue, the microstructures and features of its fibers, the composition and functions of matrix the structure and function of fibroblast, macrophage, plasma cell and mast cell. 3. The structure and distribution of reticular tissue. To be familiar with The microstructural features and distribution of dense connective tissue and adipose tissue. To understand The active substances secreted by macrophages.

Chapter 4. Cartilage and Bone To master 1. The structural features of hyaline cartilage, elastic cartilage and fibrous cartilage. 2. The structures of osseous tissue and diaphysis of long bone. 3. Four kinds of cells in the osseous tissue. 4. The arrangement of lamellae in long bone. To be familiar with 1. The structures of the cartilage. 41

2. The growth pattern of the cartilage. 3. The structure and function of the perichondrium and periosteum.

Chapter 5. Blood and Hemopoiesis To master 1. The classification of blood cells and the normal quantity of these cells. 2. The morphological features and function of erythrocytes. 3. The structural features, normal quantity and significance of reticulocytes. 4. Leukocyte: the classification of leukocytes; the microstructural features and functions of neutrophil, eosinophil, basophil, lymphocyte and monocyte; the percentage of every kind of leukocyte in normal blood. To be familiar with The structures and functions of the blood platelet. To understand 1. The roles blood platelet play in hemostasis and blood coagulation. 2. The ultra-structures of neutrophil, eosinophil, basophil, lymphocyte and monocyte. 3. The structures of the red bone marrow, the concept of hemopoietic stem cell and hemopoietic progenitor cell. 4. The generation, developmental stages and changing roles of the erythrocyte and granulocyte.

Chapter 6. Muscle tissue To master 1. The microstructures of three kinds of muscle fibers. 2. The ultra-structures of the skeletal muscle. 3. The ultra-structures of the cardiac muscle. To be familiar with The protein conformation of thick filament and thin filament. To understand 1. The contraction principle of skeletal muscle fiber. 2. The ultra-structure of smooth muscle and its contraction principle.

Chapter 7. Nerve Tissue To master 1. The constitution of the nerve tissue. 2. Neuron: the microstructures and ultra-structures of the cell body, dendrite, axon and their respective functions. 3. The concept of synapse and the ultra-structure of chemical synapse. To be familiar with 1. The classification of neuron. 2. The classification of neuroglia: the neuroglia in the central nervous system — the structures and functions of ependymal cell, astrocyte, oligodendrocyte and microglial cell; the neuroglia in the peripheral nervous system — the structures and functions of neurolemmal cell and ganglionic glial cell. 3. The classifications and structures of the nerve fiber, the constitutions of the nerve. 4. The structures, functions and distributions of the nerve ending. To understand 1. The mechanism of how the chemical synapse transmits nerve impulses. 2. The ultra-structures of the motor nerve ending.

Chapter 8. Nerve System Learn the contents of this chapter which are to be understood by you.

Chapter 9. Circulatory System To master 1. The classifications and structures of different kinds of capillaries, the ultra-structures of the continuous capillary, fenestrated capillary and sinusoid capillary. 2. The structural features of the large artery, medium-sized artery, small artery and arteriole. 3. The structure of the heart wall and the Purkinje fiber. To be familiar with 1. The relationship between the structures of capillary and the exchange of material. Relationship between the structure of arteries and their functions. 2. The histological change of the vessel wall in different kinds of arteries and the functions of these arteries. 43

3. The structures of venule, small vein, medium-sized vein, and large vein. 4. The structures of cardiac valve, the constitution and distribution of cardiac conducting system. To understand The secretory functions of the atrial muscle fibers. The concept of cardiac skeleton.

Chapter 10. Immune System To master 1. The constitution of the immune system and its major functions. 2. The structures and classifications of the lymphoid tissue. 3. The structures and functions of the thymus. 4. The structures and functions of the lymph node. 5. The structures and functions of the spleen. 6. The concept of the mononuclear phagocytic system. To be familiar with 1. The concept and the functions of the central lymphoid tissue and the peripheral lymphoid tissue. 2. The constitution and the functions of the mononuclear phagocytic system. To understand 1. The classification of immune cells and their major functions. 2. The concept of the recirculation of the lymphocytes and their functions. 3. The structures and functions of the tonsil.

Chapter 11. Endocrine System To master 1. The general structural features of the endocrine glands. 2. Thyroid gland: the microstructures of follicular epithelial cell, and its hormone, the distribution of parafollicular cell and its hormone. 3. Adrenal gland: the structural characteristics of cortex (zona glomerulosa, zona fasciculate and zona reticularis), medulla and their hormones. 4. The division of the hypophysis, the structure and function of acidophilic cell and basophilic cell in the pars distalis of adenohypophysis. 44

5. The structures and functions of neurohypophysis. The relationship between neurohypophysis and hypothalamus. To be familiar with 1. The microstructures of zona glomerulosa, zona fasciculate, zona reticularis and medullary cell of adrenal gland. 2. Hypophysis: the structures of chromophobe cell in the pars distalis of adenohypophysis, the structures of pars intermedia and pars tuberalis. 3. The characteristics of blood supply in adenohypophysis, and the relationship between adenohypophysis and hypothalamus. To understand 1. Formation and releasing processes of thyroxine. 2. The structures of parathyroid: the microstructure of chief cell, acidophilic cell and their hormones. 3. Hormones secreted by arcuate nucleus of hypothalamus. 4. The structures of pineal body.

Chapter 12. Skin To master 1. The basic structures of the skin. 2. The structures of the epidermis. The microstructural features of keratinocytes and the keratinizing processes of epidermis. 3. The structures of dermis and the features of each layer. To be familiar with 1. The ultra-structural features of the keratinocytes. 2. The structural features and functions of melanocyte and Langerhan’s cell. 3. The structural features of the hair, the sebaceous gland and sweat gland. To understand 1. The structures and functions of Merkel cell. 2. The structural features of hypodermis.

Chapter 13. Digestive Tract To master 45

1. The general structures of the digestive tract. 2. The structural features of the stomach. The structures of the fundic gland. The microstructures, ultra-structures and functions of the chief cell and parietal cell. 3. The structures of small intestine: the structures of intestinal mucosa, intestinal villi and small intestinal gland. The structures of duodenum, jejunum and ileum. To be familiar with 1. The structural features of the esophagus, colon and the appendix. 2. The relationship between intestinal villi and the digestive and absorbing functions of intestine. To understand 1. The endocrine cells of the digestive tract: the major types of the endocrine cells and their structural features and functions . 2. The lymphoid tissue of digestive tract and the associated immune functions. 3. The structural features of mucosa in oral cavity. The structure of tongue, tooth and pharynx.

Chapter 14. Digestive Gland To master 1. The structures of serous cell and mucous cell, the cell composition of the three types of acini. 2. The general structures of pancreas: the structures of acinus and ducts of exocrine portion, four kinds of cells in the endocrine portion and the functions of the hormones secreted by these cells. 3. The structures of the hepatic lobule, the microstructure, ultra-structure of the hepatocyte and the relationship between the structures and their functions. The microstructures and ultra-structures of hepatic sinusoid and perisinusoidal space. The composition and structure of portal area. To be familiar with 1. The structures of acinus and ducts of salivary gland. 2. Pancreas: the secretion of exocrine portion and its function. 3. The structures and functions of the fat-storing cell, the structures of bile canaliculi. 4. The features of the blood circulation of liver and the biliary tract in the liver. To understand 1. Features of the three kinds of salivary glands. 2. The composition of the saliva. 46

Chapter 15. Respiratory System To master 1. The structures of the trachea and bronchi. 2. The general structures of lung. Definition of the bronchial tree and pulmonary lobule. 3. The constitution and gradual structural changes of the duct part in the lung, the constitution of respiratory part in the lung. 4. The structures of alveoli, the ultra-structure and function of type I and type II alveolar cell. The composition and function of blood-air barrier. To be familiar with 1. The structures of alveolar septum, alveolar pore and interstitium of lung. To understand 1. The blood vessels of the lung. 2. Nasal cavity: the structures of the mucous membrane of vestibular region, respiratory region and olfactory region.

Chapter 16. Urinary System To master 1. The constitution of nephron and uriniferous tubule. 2. The structures of glomerulus. The microstructure and ultra-structure of renal capsule and different components of the capsule. 3. The composition of filtration barrier and its function. 4. The microstructures, ultra-structures and function of renal tubule (proximal tubule, thin segment and distal tubule). To be familiar with 1. The functions of mesangium and mesangial cell. 2. The constitution of juxtaglomerular complex, the structure and function of juxtaglomerular cell and macula densa. To understand 1. The general structures of the kidney. 2. The constitution and functions of collecting duct. The structure of renal interstitial substance. 3. The passage of circulatory system and its features in kidney. The structures of the mesangial cells. The structures of urinary tracts. 47

Chapter 17. Male Reproductive System To master 1. The structures of wall in the seminiferous tubules. 2. The structural features of the spermatogenic lineage cells and the processes of spermatogenesis. 3. The structures and functions of the Sertoli cell, the composition of the blood-testis barrier. 4. The structure and the function of testicular interstitial cell. To be familiar with 1. The general structures of the testis. 2. The process of meiosis and its significance. To understand 1. The structures of the tubulus rectus and rete testis. 2. The structures and functions of the epididymis. 3. The structures and functions of the prostate. 4. The structures of the ductus deferens.

Chapter 18. Female Reproductive System To master 1. The developmental process of the ovarian follicles. The structures of the primordial follicle, primary follicle, secondary follicle and mature follicle. 2. The process of ovulation and its significance. 3. The formation, structures and degeneration of corpus luteum. 4. The periodic change of the endometrium： the structures of endometrium during the proliferation phase, secretory phase and menstrual phase. To be familiar with 1. The general structures of the ovary. 2. The structures of the uterine wall. 3. The periodic change of the endometrium and its relationship to the periodic ovarian hormones. To understand 1. The formation of atresic follicle and interstitial gland. 2. The general structures of oviduct. 48

3. The structure of uterine cervix. 4. The structures of vaginal mucosa. 5. The structures of mammary gland.

Chapter 19. Eye and Ear Learn the contents of this chapter which are to be understood by you.

Chapter20 Introduction to Embryology To master 1. The study contents of embryology. 2. The definition of the embryonic period and the fetal period. To understand The developmental history of embryology and contemporary embryology.

Chapter 21. General Embryology To master 1. The conditions and the place of fertilization. 2. Cleavage and the process of the blastocyst formation. 3. The time, place and process ofimplantation. 4. The changes of endometrium and trophoblast during the process of implantation. 5. The formation of bilaminar germ disc and its structures and significance. 6. The formation of trilaminar germ disc and its preliminary differentiation. To be familiar with 1. The mature development of the germ cells and their capacitation. 2. The process and meaning of fertilization. 3. The differentiation of different layers of the germ disc. To understand 1. The ectopic implantation and in vitro fertilization. 2. The establishment of major features of body form. 3. Twins, multiple births and conjoined twins. 4. The composition of fetal membrane. 5. The structures and functions of the chorion. 49

6. The functions of the amnion. 7. The significance of the yolk sac and the allantois in the development of human embryo. 8. The composition and functions of the umbilical cord. 9. The composition and functions of the placenta and its blood circulation. The structures and functions of placental barrier.

Chapter22. Development of Face, Neck and Limbs To master 1. The formation of face: the formation of frontonasal process, maxillary process and mandibular process. The generation of stomodeum, median nasal process, lateral nasal process, and the formation of nose and mouth. 2. The formation of palate: the generation and mergence of median palatine process and lateral palatine process. To be familiar with 1. The formation of the branchial arch. 2. Congenital malformation: cause of the oblique facial cleft. To understand 1. The formation of tongue, teeth and thyroid gland. 2. The formation of neck and limbs, and causes of the associated congenital malformations.

Chapter23. Development of the Digestive and Respiratory system To master 1. The formation and differentiation of the primitive gut. 2. The formation of the small intestine and the large intestine. 3. The formation and development of the cloaca. 4. Congenital malformations: causes of the ileal diverticulum (Meckel’s diverticulum), umbilical fistula, congenital umbilical hernia, and abnormal rotation of midgut loop. To be familiar with 1. The formation of esophagus and stomach. 2. The formation of the liver, gallbladder and pancreas. 3. The formation and development of laryngotracheal diverticulum.

To understand 1. The formation and development of pharyngeal pouch. 2. Causes of the following congenital malformations: intestinal stenosis or stresia, imperforate anus, esophagotracheal fistula and neonatal hyaline membrane disease.

Chapter 24. Development of the Urogenital System To master 1. The origin and developmental process of the metanephros: the formation and change of ureteric bud and metanephrogenic blastema, change of the position of metanephros. 2. The development of the bladder and the urethra. 3. The development of the indifferent gonad, testes and ovaries. 4. The development of genital duct: the different development of the mesonephric duct and paramesonephric duct in male and female. 5. The causes of the polycystic kidney and the urachal fistula. To be familiar with 1. The occurred position of the genital ridge and its significance. 2. The development of pronephros and mesonephros, their interrelationship with the metanephros. 3. Congenital malformations: cause of cryptorchidism, congenital inguinal hernia, and double uterus. To understand Congenital malformations that are associated with the development of urogenital system besides those mentioned above.

Chapter 25. Development of the Circulatory System To master 1. The occurred position and significance of the endocardial cushion. 2. Partitioning of the primitive atrium and the primitive ventricle. 3. Partitioning of the bulbus cordis and the truncus arteriosus. 4. The fetal blood circulatory path, its features and the changes after birth. 5. Congenital malformations: the features and the causes of the atrial septal defect, ventricular 6. septal defect, patent ductus arteriosus and tetralogy of Fallot. 51

To be familiar with 1. The occurred position of the heart tube and its rotation. 2. The development of the heart shape. 3. Changes in the sinus venosus and formation the definitive right and left atrium. To understand 1. The establishment of primordial cardiovascular system. 2. Congenital malformations that are associated with the development of circulatory system besides those mentioned above.

Chapter 26. Development of the Nervous System Learn the contents of this chapter which are to be understood by you.

Chapter 27 Development of the Eye and Ear Learn the contents of this chapter which are to be understood by you.

Ⅳ. Practice Requirements By studying, students should achieve such levels as to distinguish the microstructures of varieties of cells, tissues and main organs and to master the relationship between the structures and functions.

Ⅴ. Ability Training Requirements Upon the completion of the histology and embryology, students will be able to: 1. Distinguish the microstructures of varieties of cells, tissues and main organs of the body; 2. Distinguish the ultra-structures of the main cells and tissues of the body; 3. Know the relationship between the structures and functions; 4. Gain a systemic knowledge about the early development of human embryo and the development of the main organs. 5. Use and take care of the light microscope skillfully.

Ⅵ. Hours Distribution Total teaching hours are 96 with 64 hours spent on the theory lectures and 32 hours on the Lab studies. Contents Lecture Lab Introduction, Epithelial tissue 4 3 Connective Tissue Proper 3 2 Cartilage and Bone 2 1 Blood and Hematopoiesis 3 3 Muscle Tissue 3 2 Nerve Tissue 2 2 Circulatory System 3 2 Immune System 4 3 Skin and its Appendages 1.5 1 Endocrine System 2.5 2 Digestive Tract 4 4 Digestive Glands 3 2 Respiratory System 2 1.5 Urinary System 3 1.5 Male Reproductive System 2.5 1 Female Reproductive System 1.5 1 General Embryology 1 3 General Embryology 2 3 Development of the Head, Neck and Limbs 2 Development of Digestive and Respiratory 4 Development of the Urogenital Systems 4 Development of the Circulatory System 4

Ⅶ. Assessment

Attendance and Performance 20% Quizzes 20% Final Test 60% Total 100%

Ⅷ. Textbook and references Text Book Textbook of Histology and Embryology(2008-3), edited by Gao Yingmao, published by People’s Medical Publishing House. Reference Books 1. Histology and Cell Biology 2. Foundations of Embryology 3. Color Atlas of Basic Histology published by McGraw Hill Companies Journals http://www.hh.um.es/index.html Useful websites http://www.med66.com/web/zuzhipeitaixue/

Biochemistry

Credits: 7 Total hours: 144 Lectures hours: 80 Experiment hours: 64 Grade: 2nd Semester: 1 Yuan Liu-Di Compiler: Email: [email protected]

Ⅰ. Course Description Biochemistry studies the molecules and chemical reactions in organisms, trying to understand the nature of life at the molecular level. It focuses on the structures and functions of macromolecules, metabolism, and the molecular mechanisms of gene expression and regulation. Biochemical research mainly usesthe principles and methods in chemistry, as well as biophysics, physiology, cell biology, genetics and immunology. The studies of structures and functions of nucleic acids and proteins, gene expression and regulation are also called molecular biology, which is an important part of biochemistry. With the development of modern molecular biology, we have discovered that life is highly ordered and consistent. Molecular biology research has made great progresses theoretically and practically. Biochemistry has become the common language of life science and the frontier research field. Medical biochemistry mainly focuses on human body, but studying human body directly has many limitations and difficulties. Thus, the basic knowledge and theories in this course are based on the researches from microorganisms, animals and plants. In fact, recent biochemical research has accumulated a lot of knowledge about human metabolism and diseases. Meanwhile, clinical practice has also gained huge amounts of biochemical materials, which greatly promote the development and application of biochemistry. Biochemistry is one of the obligatory basic medical courses for medical students. In this course, we will discuss the biochemical processes under both physical and pathological conditions of humans. We have seen more and more applications of biochemistry and molecular biology in modern medicine. It has been the important goal of modern biomedical research to illustrate the mechanism of diseases at the molecular level and find new treatment for diseases. Understanding biochemistry and the molecular mechanism of human physiological processes will be of great help

to further medical courses. Ⅱ. Contents and Requirements Introduction To be familiar with 1. Definitions of biochemistry and molecular biology 2. Importance of biochemistry and molecular biology in basic and clinical medicine Contents: 1. Definition of biochemistry and molecular biology 2. Importance of biochemistry and molecular biology in basic and clinical medicine 3. Organization of the course and learning tips

Section I. Structure and Function of Macromolecules Chapter 1. Protein Structure and Function To master 1. Average nitrogen content 2. Names, abbreviations, chemical structures and categories of 20 common amino acids 3. Covalent and non-covalent bonds in proteins 4. Primary and tertiary structure (conformations) of proteins 5. Physico-chemical properties of proteins:amphoterism, isoelectric point, high polymer, precipitation, absorbance, color reactions, denaturation. To be familiar with 1. Molecular Chaperon 2. Relation between conformation and function 3. Relation between primary and tertiary structure 4. Individual difference in primary structure and diseases To understand 1. Separation and purification of proteins 2. Protein classification Contents 1. Chemical elements in proteins 2. Amino acids, abbreviations, R groups, modified amino acids, peptide bond, main chains and side chains of polypeptides, N-terminus, C-terminus, representation of polypeptides 56

3. Primary, secondary and three dimensional (3-D) structures of proteins. 4. Conformation: main chain and side chain 5. Domains, molecular chaperon and motifs 6. Tertiary structure, protein assembly and recognition 7. Relation between structure and function:protein conformation and disease; denaturation; allostericregulation; individual differences in primary structures and diseases 8. Chemical and physical properties of proteins: amphoterism; isoelectric point; high polymer; precipitation; absorbance; color reactions; denaturation 9. Protein classifications based on symmetry, solubility, structure and function

Chapter 2. Structure and Function of Nucleic Acids To master 1. Chemical components and structure of nucleotides 2. Structure of cyclic nucleotides 3. DNA primary, secondary and tertiary structure 4. Double helix of DNA 5. Types of RNAs 6. RNA primary and secondary structure, tRNA tertiary structure 7. Physico-chemical properties of DNA and RNA To be familiar with 1. Small RNA and RNomics 2. Superhelix and nucleosome To understand 1. Ribozyme Contents 1. Components and structures of nucleosides, nucleotides and cyclic nucleotides 2. Structures of DNA: base groups; primary, secondary and tertiary structures; double helix; superhelix; nucleosome; linear and cyclic DNA; types of DNA double helixes 3. Structures of RNA: base groups; primary, secondary structures; tRNA tertiary structures and functions; types of RNAs; small RNAs and RNomics 4. Chemical and physical properties of DNA and RNA: molecular weight; denaturation

Chapter 3. Enzymes To master 1. Concept and mechanism of enzymes: catalytic efficiency, specificity, instability, and its regulation. 2. Concept of ribozyme 3. Structures and catalytic functions of enzymes: apoenzymes, cofactors, Vitamin B coenzyme, holoenzyme, essential groups, active sites 4. Activation of zymogen 5. Concept of isoenzyme 6. Kineticsof enzyme-catalyzed reactions 7. Activation and inhibition of enzymes 8. Types of inhibition and their characteristics 9. Allosteric enzymes To To be familiar with 1. Factors that affect the catalytic activity of enzymes To understand 1. Catalytic mechanism of enzymes 2. Classification of enzymes 3. Relation between enzymes and medicine Contents 1. Concept of enzymes 2. Characteristics of enzymes: 3. Structure of enzymes and the catalytic center 4. Components of enzymes 5. Concepts of apoenzyme, holoenzyme, coenzyme and cofactor 6. Concept of active site 7. Zymogen activation 8. Concept of isoenzyme 9. Concept of allosteric enzyme 10. Vitamin B and coenzyme 11. Catalytic mechanism of enzymes: activation energy, enzyme-substrate transition state, induced-fit model 58

12. Kinetics of enzyme-catalyzed reaction: concepts, initial reaction rate, effect of enzyme and substrate concentrationson reaction rate, Michaelis-Menten equation, Km, measurement of Vmax and Km, effects of temperature and pH on reaction rate 13. Activators and inhibitors 14. Modified enzymes 15. Nomenclature and classification of enzymes 16. Applications: relations between enzymes and diseases. Secretion of enzymes from damaged cells; secretion defect; enzymes used as diagnosis and treatment for diseases.

Section II. Metabolism Chapter 4 . Carbohydrate Metabolism To master 1. Concepts of carbohydrate metabolism: key enzymes, energy exchange and regulation. 2. Physiological significance of each metabolic pathway 3. Whole process of aerobic oxidation To be familiar with 1. Glycogenesis and glycogenolysis 2. Gluconeogenesis 3. Connection and dynamic balance between carbohydrate metabolic pathways 4. Generation and regulation of blood sugar To understand 1. Physiological importance of carbohydrates 2. Pentose phosphate pathway 3. Disorders of blood sugar and glucose tolerance Contents 1. Overview of carbohydrate metabolism 2. Glycolysis: key enzymes; energy generation and utilization; regulation and physiological significance 3. Aerobic oxidation. Three steps: i) generation of pyruvate; ii) pyruvate to acetyl-CoA in mitochondrion (pyruvate dehydrogenase complex and cofactors) ;iii) Tricarboxylic acid cycle (acetyl-CoA, CO2, and NADH). Generation of ATP during aerobic oxidation. Physiological significance of aerobic oxidation. 59

4. Pentose phosphate pathway. Two steps: i) oxidative branch: generation of NADPH and pentose phosphate; ii) non-oxidative branch: glucose-6-phosphate dehydrogenase, group transfer. Regulation and physiological significance of this pathway 5. Glycogen metabolism: glycogenesis and glycogenolysis. Enzyme-catalyzed reactions, UDPG production, glycogen synthase and phosphorylase. Regulation and its importance. 6. Gluconeogenesis: key enzymes, regulation and significance. 7. Blood sugar: source and usage, concentration, regulation and glucose tolerance test.

Chapter 5. Lipid Metabolism To master 1. Essential fatty acids 2. Fat mobilization and function of hormone-sensitive triglyceride lipase 3. β-oxidation of fatty acids: production of acetyl-CoA, NADH and FADH; energy exchange 4. Oxidation of fatty acids in liver: production, utilization and importance of ketone bodies 5. Synthesis of fatty acids: materials, hydrogen provider, key enzymes and regulation 6. Lipid 7. Phospholipid: classification, components, degradation and synthesis 8. Cholesterol: synthesis: key enzymes and regulation. Metabolism of cholesterol and the physiological functions of its metabolites 9. Plasma lipids: types, generation and characteristics. Metabolism of lipoproteins. To be familiar with 1. Production of chylomicrons. 2. Synthesis of lipids 3. Metabolism of unsaturated fatty acids and production of prostacyclin, thromboxane and leukotriene To understand 1. Metabolism of sphingolipids 2. Plasma lipoprotein metabolism and disorders Contents: 1. Production of chylomicrons 2. Lipid mobilization, fatty acid activation, acyl-CoA transportation, β-oxidation.Palmitic acid oxidation. Saturated fatty acid oxidation. Other oxidation pathways. Formation, types and 60

characteristics of ketone bodies. Oxidation of ketone bodies. 3. Synthesis of fatty acids: synthesis sites, materials. Key steps: malonyl-CoA formation; acetyl-CoA carboxylase, function of ACP. Fatty acid synthase. Elongation of fatty acid chain. Synthesis of unsaturated fatty acids. Essential fatty acids. Synthesis of lipids. Oxidation of polyunsaturated fatty acids. Metabolites of polyunsaturated fatty acids: prostacyclin, thromboxane and leukotriene 4. Phospholipid: classification, components, function, degradation and synthesis 5. Cholesterolsynthesis: materials, key enzymes and regulation. Metabolism of cholesterol and the physiological functions of its metabolites 6. Lipoproteins: definition, classification, characteristics and functions. Lipoprotein and plasma lipid. Plasma lipoproteins:ultracentrifugation separation and classification. Types and functions of apolipoprotein. Hyperlipidemia definition and classification.

Chapter 6. Biological Oxidation To master 1. Concept of biological oxidation, characteristics and importance 2. Electron transfer chain in mitochondrion: oxidative phosphorylation. Generation of ATP and P/O value. Other high energy chemicals 3. Respiratory chain inhibitors and uncoupling agents. To be familiar with 9. Other oxidative pathways 10. Catalase, peroxidase 11. Chemiosmotic hypothesis 12. Malate-aspartate shuttle and glycerol phosphate shuttle 13. Enzymes in microsome To understand 1. Oxidative phosphorylation coupling Contents 1. Definition of biological oxidation and oxidative phosphorylation: characteristics, importance and high energy phosphate compound. Pathways of biological oxidation and enzymes 2. Oxidation system in mitochondrion: components of respiratory chain and their functions: flavin, iron-sulfur protein, ubiquinone, cytochromes, porphyrin. Orders of respiratory chain 61

complexes: NADH oxidative respiration chain, succine acid oxidation. Electron transfer chain. Definition and function of oxidative phosphorylation. Coupling sites, P/O value. Chemiosmotic hypothesis. ATP synthase. Factors that affect oxidative phosphorylation: inhibitors and uncoupling agents. 3. Oxidase in microsome: mixed function oxidase, oxidase in peroxisome. Superoxide dismutase function.

Chapter 7. AminoAcidMetabolism To master 1. Nitrogen balance, complementary effect and protein nutrition value 2. Transamination, oxidative deaminization, transdeamination, purine nucleotide cycle 3. α-keto acid metabolism 4. Origin and catabolism of blood ammonia: transportation of ammonia and major catabolic pathway 5. Ornithine cycle (urea cycle): enzyme-catalyzed reactions of urea synthesis, importance of urea 6. Metabolites of amino acids: histamine, ᵞ- aminobutyric acid and 5-hydroxytryptamine 7. Tetrahydrofolic acid transported one carbon units: names and physiological functions 8. Functions of creatine phosphate, S-adenosylmethionine, PAPS and polyamine,etc To be familiar with 1. Metabolism of sulfur amino acids, aromatic amino acids and theirbiological functions 2. Catabolism of branched chain amino acids 3. Relationship and connection of protein, carbohydrate and lipid metabolism To understand 1. Digestion of proteins and absorbance of amino acids 2. Transformation and regeneration of proteins in the body 3. Mechanism of transamination. Hyperammonemia and ammonia poisoning Contents 1. Nutrition of proteins. Nitrogen balance. Physiological functions and nutritional value of proteins. Digestion, absorbance, and putrefaction 2. Introduction of metabolism of amino acids. Transformation and regeneration of proteins in body. Origin and catabolism of blood amino acids. Concentration of blood amino acids. 62

3. General metabolism of amino acids. Concept of transamination; transaminase catalyzed reaction, function of pyridoxal phosphate. Oxidative deamination. Transdeamination. Purinenucleotide cycle. Non-oxidative deamination. Transformation of ammonia and carbon skeletons. 4. Metabolism of ammonia. Dynamics of blood ammonia, transportation of ammonia and ornithine cycle. Urea synthetase, significance of urea synthesis. Other metabolicpathways of ammonia. Degradation and transformation of amino acids. 5. Decarboxylation of amino acids, transformation of histine to histamine, glutamic acid to ᵞ-aminobutyric acid, tryptophan to 5-hydroxytryptophan. 6. Metabolism of one carbon unit. Concept, origin and type, interaction with tetrahydrofolic acid. 7. Metabolism of sulfur amino acids. Function and significance of creatine and creatine phosphate. 8. Metabolism of aromatic amino acids: metabolism of phenylalanine and catecholamine, production of thyroxine and transformation of tryptophan. 9. Metabolism of branched amino acids.

Chapter 8. Biochemistry of Blood To master 1. Classification and properties of plasma proteins, functions of important plasma proteins 2. Synthesis of Heme 3. Characteristics and function of carbohydrate metabolism in red blood cells, ratio of albumin and globulin To be familiar with 1. Regulation of Heme synthesis 2. Carbohydrate metabolism pathway in red blood cells 3. Redox system To understand 1. Components of plasma proteins Contents 1. Classification and properties of plasma proteins, functions of important plasma proteins 2. Metabolism in red blood cells : synthesis of Heme and regulation; function of folic acid and 63

vitamin B6 in heme synthesis. Characteristics of mature red cells: glycolysis; 2,3-BPG pathway and its importance. Function of pentose metabolism, NADPH, GSH, NADH in red cells

Chapter 9. Biochemistry of Liver To master 1. Functions of liver in carbohydrate, lipid and protein metabolism 2. Importance of liver biotransformation. Function of mixed function oxidase 3. Origin, types and excretion of bile acids. Enterohepatic circulation of bile acid. Functions of bile salts. 4. Catabolism of heme: origin and transport of bilirubin; absorbance and transformation of unbound bilirubin in liver; transformation and excretion of bilirubin in intestinal tracts, bilinogenenterohepatic circulation; urobilinogen and urobilin To be familiar with 1. Biotransformation reactions 2. Synthesis of bile acids To understand 1. Metabolism of bile pigment and jaundice Contents 1. Functions of liver in metabolism: functions of liver in carbohydrate, lipid and protein metabolism 2. Function of biotransformation: concept, types and characteristics of biotransformation, influencing factors 3. Bile acid metabolism: production of primary bile acid in liver, production of secondary bile acid, excretion of bile acid and enterohepatic circulation of bile acid. Biological functions of bile acids 4. Metabolism of bile pigment: origin of bile pigment, production of bilirubin, spatial conformation of bilirubin, transportation of bilirubin, properties of unconjugated bilirubin, transformation of bilirubin, absorbance of unconjugated bilirubin, production and properties of bilirubin glucuronide. Transformation and excretion of bilirubin in intestinal tracts, bilinogenenterohepatic circulation. Urobilin and jaundice.

Section III. Information Pathways Chapter 10. Nucleotide Metabolism To master 1. Purine ribonucleotidede novo synthesis: materials and energy; procedures of nucleotides synthesis; production of IMP and its transformation to AMP and GMP 2. Pyrimidineribonucleotidede novo synthesis: key enzymes, product UMP and its transformation to CTP, production of TMP 3. Deoxynucleotide synthesis: synthesis of NTP, regulation 4. Metabolites of purine and pyrimidine To be familiar with 1. Salvage pathway of nucleotide synthesis 2. Concept and function of antimetabolite To understand 1. Uric acid and gout 2. Mechanism of antimetabolite Contents 1. Metabolism of purine ribonucleotide. Synthesis: de novo synthesis; generation of IMP and its transformation into AMP and GMP. Salvage pathway: influencing factor. Catabolism of purine ribonucleotide: generation of uric acid and introduction of gout. 2. Metabolism of pyrimidineribonucleotide. Synthesis: generation of UMP and its transformation into CTP; generation of TMP. Salvage pathway: influencing factors. Catabolism of pyrimidine and its products. 3. Synthesis of deoxynucleotide: reaction system; mechanism of ribonucleotidereductase. Synthesis of deoxyadenylic acid, NTP, dNTP. 4. Concept, mechanism and clinic significance of antimetabolite.

Chapter 11. DNA Biosynthesis To master 1. Central dogma 2. Semiconservative replication of DNA: process, enzymes and factors 3. Biological significance of DNA synthesis 4. Concept and process of reverse transcription 65

To be familiar with 1. DNA synthesis in eukaryotes 2. Experimental evidence of semiconservative replication 3. Concept of telomerase 4. DNA damage and repair To understand 1. Rolling circle replication 2. D ring replication 3. Mechanism of telomerase Contents 1. Mechanism of DNA replication: experimental evidence for semiconservative replication hypothesis 2. DNA synthesis in prokaryotes: enzymes and factors, eg DNA polymerases, helicase, ligase, primase etc. Process of replication: initiation, elongation, termination. 3. DNA synthesis in eukaryotes: basic concepts, telomerase 4. Reverse transcription: basic concepts, process, reverse transcriptase 5. Rolling circle replication and D ring replication 6. DNA damage and repair: physical and chemical causes. Types of DNA repair and the enzymes involved.

Chapter 12. RNA Biosynthesis To master 1. Mechanism and process of RNA transcription in prokaryotes: template strand and coding strand. Initiation of RNA transcription, components and functions of RNA polymerase, promoter. Elongation and termination of RNA transcription 2. RNA post-transcriptional processing and modification in eukaryotes 3. Ribozyme: basic concept, characteristics and significance To be familiar with 1) Processing and modification of tRNA and rRNA 2) Eukaryotic RNA polymerase 3) RNA replication

To understand RNA transcription process in eukaryotes Contents 1. RNA transcription template: template strand and coding strand 2. Prokaryotic RNA polymerase: subunits, core enzyme, σ factor, holoenzyme 3. Process of prokaryotic RNA transcription: initiation (promoter recognition of RNA polymerase holoenzyme via σfactor, replication origin, promoter); elongation (direction, formation of phosphodiester bond, interactions between holoenzyme and σ factors); termination (terminator sequence, ρ factor). 4. Eukaryotic RNA polymerases: types and functions. Transcription factors, transcription process and characteristics 5. Post-transcriptional processing: basic concept; mRNA, tRNA and rRNA processing. Difference of processing between prokaryotes and eukaryotes. 6. Ribozyme: concept, characteristics. 7. RNA replication

Chapter 13. Protein Biosynthesis To master 1. Protein translation machinery 2. Characteristics and functions of three types of RNAs 3. Function of aminoacyl-tRNAsynthetase 4. Formation of prokaryotic 70S initiation complex 5. Ribosome cycle To be familiar with 1. Elongation of peptide and elongation factors 2. Termination of translation and polyribosome cycle 3. Post-translational processing and modification 4. Interfering and inhibition of protein translation To understand 1. Characteristics of eukaryotic protein translation 2. Protein targeting Contents 67

1. System of protein translation: mRNA and genetic codon, characteristics of genetic codon, initiation codon, termination codon, mitochondrion genetic codon, aminoacyl-tRNA, anticodon and complementary mRNA. Assembly of ribosome and rRNA, 30S and 50S ribosome subunits. 2. Protein translation: formation and translocation of aminoacyl-tRNAs. Initiation (initiation complex, initiation factors), elongation (registration, peptidyltransferase and translocation, elongation factors), termination of protein translation, release of newly synthesized proteins. Polyribosome cycle. 3. Comparison of prokaryotic and eukaryotic protein translation: initiation complex, rRNA, recognition of initiation codon, initiation factors, components of ribosome, elongation factors and termination factors. 4. Post-translational processing and modification: protein targeting, signal peptide. 5. Interfering and inhibition of protein translation: antibiotics, toxins and interferon.

Section IV. Chapter 14. Genetic Engineering To master 1. Concepts of DNA recombination and genetic engineering, basic technical procedures 2. Types and applications of tool enzymes 3. Vectors, targeting genes and construction of recombinant DNA, transformation, selection, amplification and verification 4. Medical applications of recombinant DNA and genetic engineering To be familiar with 1. Principles of genetic diagnosis and therapy 2. Nucleic acid hybridization and DNA library To understand Relation between recombinant DNA and medicine Contents 1. Concepts of genetic engineering. Types and functions of tool enzymes. Gain of vectors and target genes, construction of recombinant DNA, transformation, selection, amplification and verification. 2. Relationship between recombinant DNA and medicine: discovery of disease genes, DNA 68

diagnosis, gene therapy and prevention of genetic diseases 3. Development of genetic engineering products

Chapter 15. PCR To master 1. Definition; 2. Taq DNA polymerase 3. 3 main steps ofPCR reaction; To be familiar with 1. Principles ofPCR reaction 2. Materials and equipment To understand Application of PCR technology Contents: 1. Polymerase chain reaction (PCR) 2. PCR is a valuable tool for amplifying a small amount of DNA or increasing the proportion of a particular DNA sequence in a population of mixed DNA molecules 3. PCR mixture contains ① sterile water;

② 10X amplification buffer withMgCl2 ③ dNTP ④ primer 1 ⑤ primer 2 ⑥ Taq Polymerase ⑦ Template DNA 4. Taq DNA Polymerase is a thermostable DNA Polymerase.Taq DNA Polymerase is the most common polymerase used for PCR 5. Three main steps of PCR reaction: Denaturation; Annealing; Elongation; 6. Application of PCR ① Diagnosis of many infectious diseases ② Determination of genetic defects in fetuses or neonates ③ Monitoring of cancer chemotherapy 69

④ Solving paternity and criminal cases ⑤ Construct recombinant DNA molecules

Ⅲ. Time Distribution

Lecture Content hours Section I Structure and Function of Macromolecules(16) Introduction 1 Chapter 1 Protein Structure and Function 5 Chapter 2 Structure and Function of Nucleic Acid 4 Chapter 3 Enzymes 6 Section II Metabolism(42) Chapter 4 Carbohydrate Metabolism 8 Chapter 5 Lipid Metabolism 8 Chapter 6 Biological Oxidation 4 Chapter 7 Amino Acid Metabolism 8 Chapter 8 Biochemistry of Blood 4 Chapter 9 Biochemistry of Liver 6 Chapter 10 Nucleotide Metabolism 4 Section III Gene Expression(16) Chapter 11 DNA Biosynthesis 6 Chapter 12 RNA Biosynthesis 5 Chapter 13 Protein Biosynthesis 5 Section IV Molecular Biological Techniques(6) Chapter 14 Genetic Engineering 4 Chapter 15 PCR 2

Ⅳ. Assessment: Final mark＝attendance＋mid-term exam＋experiment mark＋final exam Attendance: 10%

Midterm exam: 30% Experiment mark: 20% Final exam: 40%

Ⅴ. Textbooks and reference 1. Jia Hong-Ti.Biochemistry.People’s medical publishing house，2007 2. Murray Robert et al. Harper’s Illustrated Biochemistry. McGraw Hill. 29th edition. 3. P.C. Turner, A.G. Mclennan, A.D. Bates & M.R.H. White, Instant Notes in Molecular Biology, 2nd edition, Bios scientific publishers limited, 2002.

Medical Genetics

Credits: 2.5 Total hours: 48 Lectures hours: 32 Experiment hours 16 Grade: 2nd Semester: 1 Hong Fan, Compiler: Email: [email protected]

Preface Genetics is fundamental to the basic sciences of preclinical medical education and has important applications to clinical medicine, public health and medical research. With recognition of the role of genetics in medicine has come the problem of providing a place for it in the undergraduate curriculum, a problem which is as yet only partly solved in most medicine, and to give a medical student a background for his own reading of the extensive and rapidly growing literature in the field. If his (her) senior colleagues also find it useful, it shall be doubly satisfied. Medical genetics is an important subject in medical school. With the advancement of modern technology and molecular biology, there is a need to revise the syllabus of medical genetics. Medical Genetics provides medical and biomedical science students with an understanding of the basic principles of human genetics as they relate to clinical practice. Each of the initial chapters focuses on a traditional cornerstone of human genetics (molecular genetics, cytogenetics, Mendelian inheritance, polygenic inheritance, population genetics) with a major emphasis on clinical relevance. These are followed by consideration of subjects of specific medical importance such as the haemoglobinopathies, developmental genetics, cancer genetics and pharmacogenetics, with due attention to topical and evolving issues such as pharmacogenomics, gene therapy and therapeutic cloning. The final chapters provide an explanation of the genetically related clinical skills and competencies expected of a medical student, together with an overview of the principles of clinical genetics, a rapidly developing clinical specialty which now impinges on almost every aspect of medical practice. The teaching methods used in this course include lecture, lab experiments, self-study and videos. Medical Genetics is also an experimental course because all the basic theories in this class are based on experiments. Thus lab experiments are a very important part of this course. We have 72

designed four (4) lab experiments in the course in order to help students understand the related knowledge and train their ability of practice. Students should do the preview and review of materials during the semester, which will help them comprehensively grasp all the knowledge and finally, know this field. Table of Contents 1. Introduction 2. The human genome and chromosomal basis of heredity 3. Principles of clinical cytogenetics 4. Clinical cytogentics: disorders of the autosomal and sex chromosomes 5. Patterns of single –gene inheritance 6. Multifactorial inheritance and common diseases 7. Biochemical genetics: disorders of metabolism 8. Genetic variation in individuals and populations: mutation and polymorphism 9. Genetic screening and prenatal diagnosis, clinical genetics, genetic counseling, and gene therapy 10. Cancer genetics

Ⅰ.Preamble and Objectives Medical genetics deals with the subset of human genetic variation that is of significance to the practice of medicine and to medical research. Within human and medical genetics, there are many fields of interest, as indicated by the various directions in which genetics has developed. Major recognized areas of specialization are the study of chromosomes; the study of the structure and function of individual genes; the study of the genome, its organization, and functions; the study of genetic variation in human populations and the factors that determine allele frequencies; and the application of genetics to diagnosis and patient care. The objective of this course is to present the basic principles of medical genetics and their application to clinical medicine, with the intent of providing students the necessary background to understand ongoing developments in genetics and their application to clinical problems.

Ⅱ.Contents of the Course and Requirements Chapter 1. Introduction 73

Objectives 1. Know the study contents and tasks of Medical Genetics. 2. Know the developing history and the potential of Medical Genetics as well as the relationship between medical genetics and other subjects. We recommend one lecture to fulfill the content of chapter 1. 1. The study contents and tasks of Medical Genetics 2. The developmental overview of Medical Genetics 3. The relationship between Medical Genetics and other subjects 4. The developmental tendency of Medical Genetics A more detailed content of the theoretical aims is listed below: To master 1. Concept of genetic disorders 2. Classification of genetic disorders To be familiar with Hazards of genetics diseases To understand The development of medical genetics and its role in medical education

Chapter 2. The human genome and chromosomal basis of heredity Objectives 1. Master relevant knowledge of the human chromosomes. 2. Master the characteristics of meiosis. 3. Master the concept and molecular structure of genes. 4. Master the replication, expression and mutation of genes. 5. Know the process of meiosis. We recommend one lecture to fulfill the contents of chapter 2. A more detailed content of the theoretical aims is listed below: To master 1. Human chromosomes 2. X chromosome inactivation and Sex chromatin To be familiar with The characteristics and process of meiosis 74

To understand The concept and molecular structure of genes

Chapter 3. Principles of clinical cytogenetics Objective Master chromosomal aberration. We recommend two lectures to fulfill the content of chapter 3. A more detailed content of the theoretical aims is listed below: To master Chromosomal aberrations 1. The type and mechanism of numerical aberrations 2. The type and mechanism of structural aberrations To be familiar with 1. Basis of genetics of abnormal chromosomes 2. Mechanism of chromosomal disease To understand 1. Number and structures of chromosomes 2. Technique of chromosomal analysis

Chapter 4. Clincial cytogentics: disorders of the autosomal and sex chromosomes Objective 1. Know autosomal diseases. 2. Know sex chromosomal diseases. We recommend two lectures and one class exercise to fulfill the content of chapter 4. A more detailed content of the theoretical aims is listed below: To master 1. Autosomal diseases’ main clinical characteristics 2. Sex chromosomal diseases’ main clinical characteristics To be familiar with Main karyotypes of typical chromosome diseases such as trisomy syndrome and sex chromosome disorders. To understand

Main causes of the typical chromosome disorders in human being.

Chapter 5. Patterns of single–gene inheritance Objective 1. Master the types and pedigree characteristics of monogenic inheritance. 2. Know the cases of monogenic diseases. 3. Master the law of segregation and independent assortment and its analysis of heredity. We recommend three lectures and one exercise to fulfill the content of chapter 5. 1. General description of the Mendelian inheritance 2. A more detailed description of the basic concepts in single gene inheritance 3. Using clinical cases to introduce factors affecting pedigree patterns 4. Briefly introduce correlation between genotype and phenotype basing on clinical cases 5. Students are expected to know definition, typical mating types, characteristics of typical pedigrees, one typical disease example of four patterns of single gene inheritance 6. Students will also know more knowledge special to single gene inheritance 7. Briefly describe situations in which the inheritance of single-gene disorders diverges from typical Mendelian patterns. A more detailed content of the theoretical aims is listed below: To master Locus, Allele, mutation, Genotype, Phenotype, Single gene disorders, Homozygous (homozygote), Heterozygous (heterozygote，carrier), Hemizygous, Pedigree, Proband, Relationships within kindred, Consanguinity (consanguineous), First degree relatives, Second degree relatives, Third degree relatives, Fourth degree, The patterns of single gene disorders depend on two factors, Recessive, dominant, Penetrance（Reduced penetrance）， Expressivity（variable expressivity） Carrier frequency, Coefficient of inbreeding (F), Incompletely dominant (or semi-dominant) , Criss-cross inheritance, X inactivation, Lyon hypothesis, Dosage compensation, Lack of male-to-male transmission 76

Mosaicism, genomic imprinting, unstable repeat expansions To be familiar with 1. Wild-type, mutant, Mitochondrial genome, 2. Standard Pedigree Symbols, co-dominant, 3. Somatic mosaicism, germline mosaicism, the mitochondrial genome To understand Haplotype, polymorphism, compound heterozygote, pseudoautosomal inheritance. Genetic heterogeneity: Allelic heterogeneity, Locus heterogeneity, Phenotypic heterogeneity Inbreeding, Genetic isolation, Escape from X inactivation, Manifesting heterozygote, Homozygous affected females, X-linked dominant disorders with male lethality, Pseudoautosomal inheritance Three unusual features of mitochondria

Chapter 6. Multifactorial inheritance and common Diseases Objective 1. Master the characteristics of polygenic inheritance. 2. Master the characteristics of polygenic diseases. 3. Know the cases of polygenic diseases. We recommend one lecture and one class exercise to fulfill the content of chapter 6. A more detailed content of the theoretical aims is listed below: To master 1. The characteristics of polygenic inheritance 2. The characteristics of polygenic diseases To be familiar with Inheritance of multifactorial disorders To understand Examples of polygenic diseases

Chapter 7. Biochemical genetics: disorders of metabolism 77

Objective 1. Master the concept of molecular disease and inborn errors of metabolism. 2. Master the molecular mechanism of molecular diseases. 3. Master the characteristics of molecular diseases. 4. Master the molecular mechanism of inborn errors of metabolism. We recommend two lectures to fulfill the content of chapter7. A more detailed content of the theoretical aims is listed below: To master 1. The concept of molecular diseases 2. The types of molecular diseases To be familiar with Inborn errors of metabolism To understand 1. Hemoglobinopathy 2. Hemophilia

Chapter 8. Genetic variations in individuals and population: mutation and polymorphism Objective 1. Master the law of genetic equilibrium. 2. Know the effective factors of genetic equilibrium. 3. Know the concept of genetic load and inbreeding coefficient. 4. Know the concept of gene frequency and genotype frequency. We recommend one lecture and one class exercise to fulfill the content of chapter 8. A more detailed content of the theoretical aims is listed below: To master 1. Nucleotide substitution (point mutation) 2. Deletions and insertions 3. Dynamic mutations 4. Transition 5. Transversion 6. Missense mutations 78

7. Chain termination mutation 8. Nonsense mutations 9. Frameshift mutations To be familiar with 1. Mutations can be classified into three categories 2. Gene mutations can originate by either of two basic mechanisms 3. Types of mutations and their consequences 4. Silent mutations 5. RNA processing mutations 6. Uniform nomenclature for mutations To understand Human genetic diversity

Chapter 9. Genetic screening and prenatal diagnosis: clinical genetics, genetic counseling, and gene therapy Objective 1. Master the diagnostic methods and technology for genetic diseases. 2. Master the types of therapeutic methods for genetic diseases. We recommend two lectures to fulfill the content of chapter 9. A more detailed content of the theoretical aims is listed below: To master 1. Diagnostic methods and technology of genetic diseases 2. Pedigree analysis 3. Cellular genetic tests 4. Gene diagnosis To be familiar with 1. The types of therapeutic methods for genetic diseases 2. Routine therapy 3. Gene therapy To understand 1. The prevention of genetic diseases 2. Genetic counseling 79

3. Genetic screening, register, health care

Chapter 10. Cancer genetics Objective: 1. Master the relation between chromosomal abnormality and tumors. 2. Master the concept and types of oncogenes. 3. Master the concept and types of tumor suppressor genes. 4. Know the genetic theory of tumor genesis. We recommend two lectures to fulfill the content of chapter10. A more detailed content of the theoretical aims is listed below: To master 1. Oncogenes 2. Tumor suppressor genes To be familiar with The genetic theory of tumor genesis To understand Chromosomal abnormalities and tumors

Ⅲ. Teaching Methods Lectures: 3 hours / week of interactive classroom lectures to facilitate learning of terminology, principles and concepts Teacher-directed learning (problem-based): 4 hours, the problems are proposed by teachers according to the teaching contents. The students give presentations after searching materials relevant to the problems from reference books and the internet. Self-directed learning: 2 hours / month, problem-based small group discussions, question-answer sessions, revision and reinforcement of important concepts and suggestions of books and resource materials.

Ⅳ. Practice Requirements As a basic course for medical students, medical genetics contains a series of experiment classes. By this way, the students can correlate the theories with the life phenomena. Upon completion of this course, the students can learn: 1. How to recognize the typical genetic diseases in clinical hospital and daily life. 2. How to prepare the samples of chromosome from adult peripheral blood cell. 3. How to put the basic theories into our life. 4. How to give an appropriate genetic counseling 5. How to prepare and determine the X chromatin

Ⅴ. Ability Training Requirements Upon completion of this subject, students will be able to acquire: 1. Critical thinking and reasoning abilities: By studying this course, the students can do reasonable analyses and judgments for common genetic phenomena. 2. The training of experimental abilities: By studying this course, the students can grasp the basic experiment skills and cultivate their practical ability. In addition, their ability for logical analysis will be improved by analyzing the experiment results and data. 3. Self-learning abilities: Since some chapters will not be taught in class, the students have the chance to collect the necessary information after class. In this way, the students’ self-learning abilities can be cultivated. 4. Expression abilities: The students must learn to express their thoughts and solutions to some questions. Some quizzes and coursework are the necessary methods to achieve this. 5. Innovative abilities: By studying this course, the students can practise their ability of independent thinking and solving problems. They will learn the methods of giving reasonable explanations to related life phenomena and design the simple experiments to test them.

Ⅵ.Hours Distribution

Content Credit Hours Lab 32 16 1. Introduction 1 2. The human genome and chromosomal basis of heredity 2 4 3. Principles of clinical cytogenetics 3 4 4. Clincial cytogenetics: disorders of the autosomal and sex chromosomes 3 5. Patterns of single –gene inheritance 6 4 6. Multifactorial inheritance and common diseases 3 7. Biochemical genetics: disorders of metabolism 3 8. Genetic variations in individuals and population: mutation and 3 polymorphism 9. Genetic screening and prenatal diagnosis: clinical genetics, genetic 3 4 counseling, and gene therapy 10. Cancer genetics 3 Final Exam 2

Ⅶ. Textbooks and reference Textbook 1. Robert Nussbaum， Roderick R. McInnes PhD FRS(C)，Huntington F. Willard PhD Thompson & Thompson Genetics in Medicine Publisher: Saunders 2. Mclnnes, Willard,张咸宁(编者),祁鸣(编者),等(编者) Textbook of Medical Genetics Reference 1. Ricki Lewis, Human Genetics: Concepts and Applications, 6th Edition, McGraw-Hill, 2004. 2. Hartwell, Genetics: From Genes to Genomes, 2nd Edition, McGraw-Hill, 2003. 3. Marshall Horwitz, Basic Concepts in Medical Genetics, 1st Edition, McGraw-Hill. 2002. 4. William S. Klug, Essentials of Genetics, 5th Edition, Pearson Education, 2005.

Ⅷ. Assessment Examination pattern: 1. Paper test: Check the contents of lectures 2. Review: Check the contents of teacher-directed and self-directed learning Marks distribution: (Total mark is 100.) 1. Paper test: 70% (Mid-term Examination: 30% Final Examination: 40%) 2. Review: 5% 3. Attendance: 5% 4. Experiments: 20%

Physiology

Credits: 7 Total hours: 144 Lectures hours: 80 Experiment hours 64 Grade: 2nd Semester: 1 Xiao-Niu Dai Compiler: Email: [email protected]

I. Contents of Physiology Chapter 1. INTRODUCTION To master 1. The concept of “homeostasis” in physiology and medicine 2. The negative feedback loops and the roles in homeostasis maintenance 3. Positive feedback loops and mechanisms To be familiar with The extracellular and intracellular compartments of the body and their significance To understand 1. The role of negative feedback inhibition in regulation of hormones secretion, using insulin as an example 2. The roles of the nervous and endocrine systems in physiological regulation 3. Feed-forward control

Chapter 2. BASIC FUNCTIONS OF CELLS To master 1. The carrier-mediated transport 2. The facilitated diffusion of glucose through cell membranes 3. Phagocytosis, pinocytosis, receptor-mediated endocytosis and exocytosis 4. Distinctions between passive transport and active transport 5. Mechanisms of an equilibrium potential production if only one ion is able to diffuse through a cell membrane

6. Mechanisms of resting membrane potential production 7. Depolarization, repolarization and hyperpolarization 8. The mechanisms of resting membrane potential being slightly different from the potassium equilibrium potential and the effects of the extracellular potassium concentration on the resting membrane potential 9. Voltage regulated Na+ and K+ channels and their roles in the production of action potential 10. Properties of action potentials and the significance of the all-or-none law and the refractory periods. 11. Transmission of action potentials along myelinated and unmyelinated axons 12. Sliding filament theory of contraction To be familiar with 1. The fluid-mosaic model of membrane structure 2. The structure of the plasma membrane and its significance in cellular function 3. The diffusion of nonpolar molecules, inorganic ions and water through cell membrane 4. Active transport and how the Na+/K+ pumps works 5. Roles of the Na+/K+ pumps in the maintenance of the resting membrane potential 6. The muscle twitch and mechanisms of summation and tetanus production 7. The cross-bridge cycle and the role of ATP in muscle contraction 8. The role of tropomyosin and troponin in muscle contraction and relaxation 9. The role of Ca2+ and the sarcoplasmic reticulum in excitation-contraction coupling To understand 1. The factors that influence the rate of diffusion through cell membrane 2. The macroscopic and microscopic structure of skeletal muscles 3. The structure of myofibrils and how it accounts for the striated appearance of skeletal muscle fibers 4. distinctions among skeletal muscle, smooth muscle and cardiac muscle in terms of structure and physiology

Chapter 3. BLOOD To master 1. The structure, function and life cycle of platelets 2. The three events of hemostasis and the reactions necessary for coagulation 85

3. Intrinsic and extrinsic blood clotting pathway 4. The ABO and Rh systems of blood typing To be familiar with 1. The composition and functions of blood 2. The composition of plasma and the specific functions of the plasma proteins 3. The structure and function of red blood cells To understand 1. Disorders of hemostasis 2. Agglutination and its relationship to transfusion 3. ABO blood types and antigen(s) on the red blood cells and the antibody(ies) in the plasma 4. Explanation why a person with type O blood cannot receive a transfusion of type A blood 5. Problems that will arise if the mother is Rh- type and the father is Rh+ type. Explanation of the causes

Chapter 4. CIRCULATION To master 1. Electrophysiological properties of heart 1) The ionic mechanisms of the resting potential and action potential in cardiac muscle cells 2) The mechanisms of pacemaker potentials including the maximal diastolic potentials and action potentials 3) The different properties of periodic excitation of cardiac muscle (cardiac m.) 4) The property of conducting system and the cardiac m. conduction in association with the sequence of excitations in different parts of the heart and the functional meaning of the sequence 2. Blood pump function of heart 1) Excitation-contraction coupling in cardiac m. in association with special properties of heart contraction and its functional significance 2) Mechanical events in cardiac cycle 3) Heart output and influencing/regulating factors 3. Blood circulation dynamics 1) Blood vessels 86

2) Biophysics of blood flow 3) Blood pressure 4) Capillary circulation 5) Lymphatic circulation anatomy and interstitial fluid uptake 6) Venous circulation 7) Blood pressure in arteries: mechanisms and influencing factors 4. Mechanisms for regulation of Cardiac Function 1) Systemic regulation by nervous system including Baroreceptor reflex and medulla center 2) Systemic regulation by hormones including vasopressin, norepinephrine, epinephrine and Angiotensin II, Kinins, VIP and ANP To be familiar with 1. Cardiac reserve 2. Heart Sound and cardiophonogram 3. Electrocardiogram 4. Venous return blood volume and influencing factors 5. Capillary circulation 6. Chemoreceptor for cardiac-pulmonary reflex 7. Circulation in special organs To understand 1. The functional features of different blood vessels 2. Arterial pulse 3. The material exchange between blood and interstitial fluid 4. Local regulation and reagents involved

Chapter 5. RESPIRATION To master 1. The significance and basic processes of respiration including definition of respiration, the three processes, transportation of gas in the blood, and internal respiration 2. The principles of pulmonary ventilation and gas exchange, including: 1) Alveoli and respiratory membrane 2) he surface tension of the alveoli and the surfactant (dipalmitoyl phosphatidyl choline, 87

DPPC) 3) Recoil force of the lung and the intrapleural pressure. Pneumothorax 4) Mechanics of ventilation, principles of pulmonary ventilation and resistances to ventilation 5) Pulmonary compliance and airway resistance 6) Pulmonary volume and pulmonary capacity 7) Ventilation 8) Gas exchange 3. The transportation of Oxygen (O2) and Carbon dioxide (CO2) in the blood 1) Oxygen transportation and influencing factors 2) Carbon dioxide transportation and influencing factors 4. The regulation of respiration 1) Respiratory center and generation of respiratory rhythm 2) Respiratory reflex including pulmonary stretch reflex and respiratory chemoreflex, and influencing factors, such as PCO2, PO2 and pH To be familiar with Oxyhemoglobin dissociation curve and influencing factors: pH and PCO2 (Bohr effect), temperature, DPG, CO, fetal hemoglobin To understand Carbon dioxide dissociation curve and Haldane effect

Chapter 6. DIGESTION AND ABSORPTION To master 1. Food digestion and absorption 2. The neural and hormonal regulation of secretory function and motility of digestive tract 3. The chemical and mechanical digestion in stomach To be familiar with The chemical and mechanical digestion in small intestine To understand 1. The digestion in Oral Cavity and esophagus 2. Digestion in Oral Cavity 3. Digestion in Large Intestine 88

4. The absorption in small intestine

Chapter 7. ENERGY METABOLISM AND BODY TEMPERATURE To master 1. Metabolic rate and the influencing factors 2. Basal metabolic rate (BMR) 3. Respiratory quotient (PQ) 4. Core temperature 5. Main organs to produce heat in different conditions (rest status and active status) 6. Ways of heat loss: Thermal radiation; Thermal conduction; Thermal convection; Evaporation 7. The main ways for heat lose when the surrounding temperature changes To be familiar with 1. Basal conditions for measuring the basal metabolic rate (BMR) 2. Body temperature measurement in clinic 3. Heat production: Shivering and Non-shivering thermogenesis 4. Ways of heat loss: the skin; expiration from lungs; feces from excretory organs 5. The effect of “set-point” in body temperature regulation To understand 1. The unit of energy; energy input and output 2. Factors affecting normal body temperature: Circadian rhythm, Sex, Age, Muscular activity 3. Regulation of the body temperature: Behavioral thermoregulation and autonomic thermoregulation 4. The thermoregulatory center located in the Hypothalamus

Chapter 8. FORMATION AND EXCRETION OF URINE To master 1. Filtration membrane and its characteristics 2. The mechanisms of urine formation (Glomerular filtration; Tubular reabsorption; Tubular secretion) 3. Glomerular filtration rate (GFR) 4. Effective filtration pressure (EFP) and the factors that can affect EFP 5. Tm (transport maximum) 89

6. Sodium and water reabsorption in different segments of the tubule 7. Glucose reabsorbed in the first proximal tubule. (The renal threshold for glucose) 8. The form of bicarbonate ion re-absorption: CO2 9. Tubular secretion (H+, NH3 or NH4+) 10. Osmotic diuresis 11. Regulation of tubular re-absorption by hormones: ADH and Renin-Angiotensin-Aldosterone System To be familiar with 1. The structures of categories and characteristics of nephrons 2. Juxtaglomerular apparatus and the two kinds of functional cells: 3. Juxtaglomerular cells (releasing rennin); macula densa (detecting changes in volume and NaCl concentration in distal convoluted tubule —juxtaglomerular cells to regulate the secretion of rennin) 4. The paths for tubular re-absorption: (transcellular route and paracellular route) 5. Material re-absorption in proximal tubule: (about 65%) 6. Concentrated and diluted urine by kidneys 7. Hyperosmolarity in the renal medulla: (outer medulla: NaCl; inner medulla: NaCl and urea) To understand 1. The structure of the kidneys and urinary system 2. Permeability of filtration membrane: Size and Electrical charge 3. Renal blood flow and its regulation 4. Nervous and hormonal regulation of GFR and renal blood flow 5. Innervation of the kidney 6. Reabsorption about potassium (Kalium) 7. Mechanisms for formation of hyperosmolarity in the renal medulla 8. Regulation of urine formation by nervous system

Chapter 9. PHYSIOLOGY OF THE SENSE ORGANS To master 1. Terms: Adequate stimulus, adaptation, dark adaptation, light adaption 2. The photoreceptor mechanism 3. Auditory receptors 90

To be familiar with 1. Coding of sensory information 2. Accommodation To understand 1. The image-forming mechanism 2. Color vision 3. Sound transmission

Chapter 10. FUNCTIONS OF THE NERVOUS SYSTEM To master 1. Structure of neuron and the functional meanings of its principal regions 2. Classification of neurons in accordance with their structures and functions 3. Compositions and functional ways of the reflex arc 4. The structure and functions of muscle spindles and the mechanisms involved in a stretch reflex 5. The action of gamma motor neuron in the neural control of muscle contraction and in the maintenance of muscle tone 6. Classifications of ion channels regulated chemically, and the mechanisms of channel work, taking nicotinic and muscarinic ACh receptors as examples. 7. EPSPs and IPSPs, presynaptic and postsynaptic inhibition 8. Motor unit and its role in control of muscle contraction 9. Characteristics of the autonomic system, difference from those involved in the control of skeletal muscle. 10. Autonomic innervations of involuntary effectors, difference from the innervations of skeletal muscle 11. The structure and general functions of the sympathetic division of the autonomic system 12. The structure and general functions of the parasympathetic division of the autonomic system 13. Neurotransmitters of the preganglionic and postganglionic neurons of the sympathetic and parasympathetic systems 14. The sympathetic system and the adrenal medulla 15. Different types of adrenergic receptors and their roles in physiology and clinic 16. The classifications and functions of cholinergic receptors 91

To be familiar with 1. The function of Golgi tendon organs 2. Reciprocal innervation and neural pathways involved in a crossed extensor reflex 3. Distinctions between EPSPs and action potentials 4. Locations and functions of the sensory cortex and motor cortex 5. The role of the basal nuclei and cerebellum in motor control via the extrapyramidal system 6. The lateralization of functions in the right and left cerebral hemispheres 7. Types of memory and the roles of different brain regions in memory 8. The structures involved in the control of speech and explanation of their interrelationships 9. The antagonistic, complementary, and cooperative effects of sympathetic and parasympathetic innervations in different organs To understand 1. The functions of glial cells in the central nervous system 2. Myelin sheath formation 3. The mechanisms of autonomic system controlled by the brain 4. The inhibitory effects of glycine and GABA in the central nervous system 5. The polypeptide neurotransmitters and the significance of endogenous opioids in the nervous system 6. The organization of the cerebrum and the primary roles of its lobes 7. The origin and pathways of the pyramidal motor tracts and the significance of these descending tracts 8. The anatomical structures of the limbic system and its possible role in emotion 9. The location of the thalamus and explanation of the function of this region 10. The location of the hypothalamus and the function of this region 11. The different types of aphasias resulting from injuries to specific brain regions

Chapter 11. ENDOCRINOLOGY To master 1. Physiological effects of growth hormone, thyroid hormones, glucocorticoid 2. Control of growth hormone secretion 3. Regulation of thyroid secretion 4. Terms: permissive action 92

To be familiar with 1. The hypothalamo-adenohypophysial system 2. Physiological effects of vasopressin, epinephrine, norepinephrine, insulin and glucagon 3. Regulation of glucocorticoid secretion To understand 1. The hypothalamo-neurohypophysial system 2. Physiological effects of prolactin, oxytocin and parathyroid hormone 3. Regulation of insulin secretion 4. Clinical correlation of thyroid hormones

Ⅱ.Hours Distribution

Content Lecture hours Introduction 2 Physiology of the cell 10 Blood 3 Circulation 15 Physiology of respiration 7 Physiology of digestion 6 Physiology of urine formation 9 Energy metabolism and body temperature regulation 3 Neurophysiology 15 Sense organ 5 Endocrinology 5

Ⅱ. Experiments of Physiology Experiment 1. The Protocol of Cervical Operation on Rabbit Objectives Develop students’ operational skills and ability; Preparations before operation Handling 2. Weighing 3. Anesthesia: 25% urethane (4ml/kg, i.v.) ; time > 5min). 4. Fixing 5. Shearing Operation in the neck 1. Slice the skin; Separate the subcutaneous tissue and muscle 2. Endotracheal intubation 3. Separate the R. Depressor N. and the R. Vagus N. 4. Intubation in the common carotid artery

Experiment 2. The Protocol of Belly Operation on Rabbit Objectives Develop students’ operational skills and ability; Procedures 1. Remove the rabbit from its cage. 2. Weigh the rabbit on the balance. 3. Intravenous anesthesia. (Urethane 25%, 4ml/1kg intravenous) 4. Fixing 5. Tracheal intubation 6. Dissect minor diaphragm muscle 7. Bladder intubation

Experiment 3. Regulation of the Blood Pressure Objectives 1. To develop the skill of direct measurement of arterial blood pressure 2. To grasp the mechanism of nervous and hormonal regulation of blood pressure Operation in the neck 1. Preparations: a) Handling b). Weighing c). Anesthesia: 25% urethane (4ml/kg, i.v.) ; time > 5min). d). Fixing e). Shearing 94

2. Slicing in the skin and separation of the subcutaneous tissue and muscle 3. Endotracheal intubation 4. Separation of the R. Depressor N. and the R. Vagus N. 5. Intubation in the common carotid artery Items 1. Record the 1st and 2nd order waves of blood pressure 2. Clip the RCCA with bulldog clamp for 5-10s, to observe the blood pressure changes 3. Stimulate R. Vagus N. (5-10V, 100 Hz, 5-10s), to observe the blood pressure changes 4. Intravenous administration of norepinephrine (1/10000) 0.3 ml, to observe the blood pressure changes 5. Intravenous administration of epinephrine (1/10000) 0.3 ml, to observe the blood pressure changes 6. Intravenous administration of acetycholine (1/10000) 0.3 ml, to observe the blood pressure changes

Experiment 4. Regulation of Respiration Objectives To observe the effects of a series of factors on respiratory movement and to analyze the mechanism of their actions. Principle Respiratory movement is controlled by rhythmic activity of respiratory center. Respiratory depth and frequency will change with the changes in internal and external environment. These changes are caused by regulations of nervous system. Main regulators include respiratory center, pulmonary stretch reflex and chemical control of breathing, and so on. When arterial PO2 decreases or PCO2 and hydrogen-ion concentration increase, ventilation is relatively increased. Experimental animal: Rabbit Experimental instruments and materials A suit of surgical instruments, rabbit’s operation table, a tracheal cannula, two 20cc and a 2cc syringes, a bar of 50cm rubber tube, a bag of carbon dioxide, a tension transducer, a stimulator, one computer, 25% urethane (4ml/kg), 3% lactic acid (2cc/rabbit), gas of carbon dioxide, 0.9%NS (normal sodium), etc. Experimental procedures 95

1. Handling, Weighing, Anesthesia and Fixing rabbit 2. Separate the subcutaneous tissue and muscle: Expose the trachea. 3. Endotracheal intubation 4. Separate the right and left vagus nerves 5. Separate small diaphragm muscle: First find xiphoid process (anatomic marker). 6. Connect with computer: Use a thread to connect hook with tension transducer. 7. Recording: 8. Experimental items Items 1. Increase CO2 concentration in inspiratory gas, and then observe the change of respiratory movement curve. Why is this change? 2. Increase dead space and observe the change of respiratory movement curve. Why is this change? 3. Increase airway resistance and observe the change of respiratory movement curve. Why is this change? 4. Inject 3% lactic acid 2cc into marginal ear vein and observe the change of respiratory movement curve. Why is this change? 5. Observe pulmonary stretch reflex phenomenon and analyze it. Inject 20cc air into the rabbit’s lung at the end of inspiration, then stop 5-10s, and then remove the syringe. Wait until the rabbit’s respiratory movement curve recovers to normal state. Then draw 20cc air from rabbit’s lung at the end of expiration, then stop 5-10s, and then remove the syringe. Observe the changes of respiratory movement curve. Why is this change? 6. Cut down right and left vagus nerves, repeat the process of 5th item. Observe the changes of respiratory movement curve. Why is this change? 7. Save the file when you finish the experiment. Print the results

Experiment 5. Regulation of the Urine Formation Objective 1. To investigate the effects of increased plasma volume, hyperglycemia, norepinephrine, furosemide on volume of urine. 2. To understand the underlying mechanisms. Principles 96

The formation of urine includes three renal processes: (1) glomerular filtration, (2) tubular reabsorption of filtrate and (3) tubular secretion. Any factors that affect these three processes of urine formation will influence the urine volume and components of the urine. Because of the high permeability of the glomerular membrane, all the components in the plasma except plasma protein are filtered into Bowman’s capsule. The volume of filtrate is determined not only by hydrostatic pressure and colloid osmotic forces across the glomerular membrane, but also by the permeability and surface area of filtration membrane. Norepinephrine (NE), which is a neurotransmitter released from sympathetic nerve endings, constricts renal arteries to decrease glomerular hydrostatic pressure, and decrease the volume of urine. Glucose stays in the urine, increasing its osmolarity, and causing increased urine volume. Furosemide, an inhibitor of the Na+-K+-2Cl- co-transporter located in the thick segment of the ascending limb, can greatly decrease the reabsorption of these ions, to cause large quantities of water to be excreted (polyuria). Animal: rabbit Materials: Balance, syringe, scissors, forceps, hemostatic forceps, operating table, urethral catheter, drop counter, 25% urathane, 0.01% norepinephrine, 10 mg/ml furosemide, saline solution, 20% glucose solution, ADH. Operation Procedure 1. Operation in the neck: 2. Lower belly operation: intubation of the bladder 3. Connect the cannula of artery to the blood pressure transducer and the intubation of bladder to the urine drop recorder. Then record the blood pressure and urine drop with the computer simultaneously. Items After finishing the following items, record the blood pressure and the urine drop simultaneously and discuss the mechanisms. 1. Saline solution: Inject 20 ml saline solution into the ear vein quickly. 2. Stimulate the right Vagus nerves (stimulation parameters: duration: 10ms, frequency: 100Hz, intensity: 5-10V). 3. Glucose solution: Inject 5 ml 20% glucose into the ear vein. 97

4. NE: Inject 0.3 ml 0.1% NE into the ear vein. 5. Furosemide: Inject 5 mg furosemide for 1 kg body weight into the ear vein. 6. ADH: Inject 2 units of ADH in the ear vein.

Experiment 6. The experiment of Compound Action Potential (CAP) of the Nerve Trunk Objectives 1. Observe the wave-form of the CAP of the sciatic nerve trunk 2. Learn the measurement of the conduction velocity of CAP Principles CAP is the symbol when the nerve trunk is excited. The nerve trunk is composed of many nerve fibers. It is a compound potential change that a lot of action potentials of nerve fibers synthesize. So the CAP of the nerve trunk is different from the one of single nerve fibers and the amplitude of the CAP of nerve trunk can vary in a certain range as the stimulation intensity changes. If two leading electrodes are placed on the surface of a normal nerve trunk, two reverse potential deflections will be induced, that are called a biphasic action potential A unidirectional action potential deflection is induced that is named as monophasic action potential. The conduction velocity of action potential (AP) is different between different kinds of nerve fibers. The conduction velocity (V) of sciatic nerve is 20-50m/s. Measure the distance (d) of nerve impulse conducting on nerve trunk and the time (t). Then we can calculate the conduction velocity by V=s/t Observation items 1. Observation of the biphasic AP. 2. The relationship between stimulation intensity and compound action potential: 3. Under the same condition, do the following experiment. 4. Measurement of the conduction velocity of action potential. 5. Monophasic action potential.

+ R1 R2 R3 R4

[Notice] Do not hurt the nerve during the separation in order to avoid influencing the results. The sciatic nerve specimen should be as long as possible. Wash it with Ringer’s solution on time s to keep its good excitability. Keep the nerve trunk in good touch with electrodes.

Experiment 7. Auscultation of the Heart Sound and Measurement of the Blood Pressure Objectives 1. To study the method of auscultation of the heart sounds. 2. To know the characteristics of the normal heart sounds. 3. To correlate the heart sounds with the opening and closing of cardiac valves during the cardiac cycle and with systole and diastole of the ventricle. 4. To study the method of Blood Pressure Measurements. 5. To know the normal value of blood pressure.

Experiment 8. Evaluation Standards for Surgical Skills

Student’s Name: ID No.: Class No.: Task 1: The rabbit handing, weighing, anesthesia and fixation (full mark: 100) Appropriate handling and weighing of the rabbit 15 Appropriate loading of the syringe with anesthetic 15 Appropriate intravenous injection 25 Monitoring the Depth of Anesthesia 25 Secure the rabbit’s head 10 Secure the rabbit’s limbs 10 Task 2: Tracheal catheterization through tracheotomy (full mark: 100) Surgical preparation of the incision site 10 Appropriate skin incision e.g. length, position 15 Dissection of subcutaneous connective tissue 15 Blunt dissection of ventral neck muscles 20

Separation of the trachea 15 Proper tracheal catheterization e.g. position, fixation 25 Task 3: Separation of structures enveloped in carotid sheath (full mark: 100) Proper Handling of tissue 20 Identify structures enveloped in carotid sheath 20 Separation of the structures enveloped in carotid sheath 40 Marking of the structures separated 20 Task 4: Dissecting of minor-diaphragm-muscle (full mark: 100) Surgical preparation of the incision site 10 Appropriate skin incision e.g. length, position 10 Dissection of subcutaneous connective tissue 10 Safe entry of peritoneal cavity 20 Appropriate dissection of minor-diaphragm-muscle 20 Careful dissection of xiphoid 15 Attention to hemostasis 10 Safe trimming and securing of xiphoid 5 Task 5: Urinary bladder catheterization (full mark: 100) Surgical preparation of the incision site 10 Appropriate skin incision e.g. length, position 10 Dissection of subcutaneous connective tissue 10 Safe entry of peritoneal cavity 20 Careful management of bladder 15 Preparation of bladder catheter 10 Proper bladder catheterization e.g. position, fixation 25 Task 6: Carotid artery catheterization (full mark: 100) Proper Handling of tissue 20 Isolation of the carotid artery 20 Heparinization (Systemic and Regional) 20 Temporary blocking of the carotid artery 20 Proper artery catheterization e.g. position, fixation 20

100

Ⅲ. Assessment

Mid-term Test 40% Final Test 40% Experiments 20% Total 100%

Ⅳ.Reference books 1. Textbook of Physiology. Yan Jianqun & Wu Bowei. Science Press 2007 2. Human Physiology: The Mechanism of Body Function. 8th edition. Vander AJ. McGraw-Hill companies.

101

Medical Immunology

Credits: 5 Total hours: 64 Lecture hours: 48 Experiment Hours 16 Grade: 2 Semester: 2 Jun Dou Li-Xin Wang Chuan-Lai Shen Compilers: Li-Wei Lu Ning Pan Email: [email protected]

Ⅰ.Contents and Requirements Chapter 1. Fundamentals of Immunology To master Immunity, innate immunity, adaptive immunity and immune system. To be familiar with Immune Cells, Secondary (peripheral) Lymphoid Tissues and Organs, Lymphocyte recirculation. Course Contents 1. Immunity, innate immunity, adaptive immunity. Immune Cells such as Phagocytes, 2. Primary Lymphoid Organs (Thymus and bone marrow), Secondary (peripheral) Lymphoid Tissues and Organs (Gut Associated Lymphoid Tissue, Mucosal lymphoid system), Lymphocyte recirculation. 3. Lymphocytes, Antigen Presenting Cells (APC), NK Cells, Pathological Immunity and Immune Diseases, Challenges of the immune system.

Chapter 2. Brief History and Prospect of Immunology Objective Knowing Brief History and Prospect of Immunology, Burnet’s Clonal Selection Theory, Humoral and Cellular immunity. Immunology’s application. Course Contents Burnet’s Clonal Selection Theory, Empirical Immunology, Scientific Immunology, Antigen

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Receptor, Signaling Pathway, Programmed Cell Death, Development of Immune Cells, Immunological Tolerance, Edward Jenner, Louis Pasteur, Robert Koch, Humoral and Cellular immunity. Immunology application such as antigen-antibody interaction, ELISPOT, immunofluorescence, Western blotting, Flow cytometry, etc. Application of Vaccines.

Chapter 3. Antigen To master Concept and properties of antigens (Ag), Physicochemical properties, Factors influencing immunogenicity, T-dependent Ag(TD-Ag), T-independent Ag( TI-Ag), Heterophilic Ag(common Ag). To be familiar with Common antigen and Cross Reaction, TCR, BCR To understand Conformational and liner epitopes, frequent antigens. Course Contents 1. Concept and properties of antigen (Ag), epitope, immunogens, happen (incomplete Ag ). 2. Physicochemical properties, T and B cells epitopes, Conformational and liner epitopes. 3. Thymus dependent Ag(TD-Ag), Thymus independent Ag(TI-Ag), Heterophilic Ag(common Ag), Common antigen and Cross Reaction. 4. Factors influencing immunogenicity, Effect of host on immunogen, 5. T-dependent TCR, BCR, MHC, Mode of Contact (Route of administration, Dose). Xenogenic Ag, Allogenic Ag, Autoantigen, Super Ag, Adjuvants, Mitogen.

Chapter 4. Immunoglobulins To master Concept of Immunoglobulins (Ig), Molecular structure and Functions of Ig, Ig Classes, Subtypes. To be familiar with Ig Isotypes, Allotypes, Idiotype; Properties and functions of monoclonal antibody. To understand Antigen Antibody Interactions, Use of antibodies in Medicine. Course Contents 1. Concept of Immunoglobulins (Ig), Molecular structure and functions of Ig 103

2. (Neutralize toxins, Bind to bacterial surfaces and aid in opsonization, Bind to bacterial surfaces and aid in complement killing, Inactivate viral particles, Provide immunity to the unborn, Provide immunity to the newborn, Complement Activation). 3. Ig Classes, Subtypes (IgM, IgD, IgG, IgA and IgE) and types. 4. Ig Isotypes, Allotypes, Idiotype; Ig Hinge region, Membrane and secreted Ig; Biological properties and functions of Ig Classes. 5. Antigen Antibody Interactions, Immunoglobulin Supergene Family, Mechanisms for generation of different antibodies, molecular diversity. 6. Use of antibodies in medicine, Properties and functions of monoclonal antibody.

Chapter 5. Complement system To master concept of complement system, biological consequences of complement system, To be familiar with the key steps of three pathways for complement system activation To understand regulation of complement system Course Contents Concept of complement system, the component of complement system, nomenclature of complement system, classical pathways, lection pathway, alternative pathway, terminal sequence and the membrane attack complex, regulation of complement system activation, biological consequence of complement activation .

Chapter 6. Cytokines To master concept of cytokines To be familiar with common properties of cytokines, classification of cytokines To understand concept of cytokine receptor Course Contents Common properties of cytokines, classification of cytokines, cytokine receptor 104

Chapter 7. MHC To master concept of HMC and HLA, structure of MHC class I and MHC class II molecules, MHC restriction, distributions of MHC class I and class II molecules, To be familiar with main functions of MHC molecules, concept of polymorphism To understand interaction of MHC and antigenic peptide, genetic properties of MHC, MHC and rejection Course Contents Concept of HMC and HLA, structure of MHC class I molecules, structure of MHC class II molecules, concept of polymorphism, peptide-MHC interaction, function of MHC molecules, HLA and clinical medicine

Chapter 8. CD and CAM molecules To master the concept of CD molecule To be familiar with clinical applications of CDs and their antibodies Course Contents Concept of leukocyte differentiation, antigens, concept of cluster of differentiation, intergrin family, selectin family, immunoglobulin family, clinical application of CD molecules, CAM and monoclonal antibodies against CD molecules and CAM

Chapter 9. Hematopoietic stem cells To master The major lymphoid organs and tissues. To be familiar with The proliferation and differentiation of hematopoietic stem cell (HSC). To understand The major functions of major immune cells. Course Contents 1. Major lymphoid Organs and tissues. 105

1) Primary organs ① Bone marrow ② Thymus 2) Secondary organs ① Lymph nodes ② Spleen ③ MALT 2. Functions of major immune cells 1) Epithelials 2) Phagocytes 3) Neutrophils 4) Monocytes & Macrophages 5) Dendritic Cells 6) NK cells 7) T lymphocytes 8) B lymphocytes

Chapter 10. Cells of Innate Immunity To master The cell types involved in innate immunity, the Pattern Recognition Receptor (PRR) and Pathogen Associated Molecular Pattern (PAMP). To be familiar with The phagocytes and their functions. To understand The major surface molecules of cells involved in innate immunity, the derivation and maturation of cells involved in innate immunity, the cytokines secreted by cells of innate immunity. Course Contents 1. PRR and PAMP 2. Dendritic cells (DC) 3. Phagocytes 1) Neutrophils 2) Mononuclear phagocytes 106

4. NK cells 5. Surface molecules 3) KAR: function 4) KIR: function 6. Functions 5) Natural killing 6) ADCC 7) Regulation of the immune response 7. Characteristics of cytotoxicity mediated by NK cells. 8. T cells 9. B1 cells 10. NK T cells

Chapter 11. T lymphocytes To master The subpopulations and functions of T lymphocytes, the development and maturation of T lymphocytes in thymus. To be familiar with The major surface molecules associated with activation and subpopulations of T lymphocytes, the cytokines secreted by T lymphocytes. Course Contents 1. Development and maturation of T cells 1) TCR rearrangement 2) Positive selection 3) Negative selection 4) MHC-restriction 5) Central tolerance 2. Surface molecules of T cells 1) TCR: structure and characteristics of antigen recognition 2) CD3: structure and function 3) CD2: structure, ligand and function 4) Co-receptor (CD4/CD8): structure, ligand and function 107

5) Co-stimulator receptor (CD28/CTLA-4): ligand and function 6) Adhesion molecules: classes and functions 7) Mitogen receptors: PHA and ConA receptor 3. Subpopulations of T cells 1) TCR T cells and TCR T cells 2) CD4+ cells and CD8+ T cells 3) Th cells (Th1, Th2), Tc, Treg

Chapter 12. B lymphocytes To master 1. The development, derivation and maturation of B lymphocytes. 1) B cell differentiation and Ig gene rearrangement. 2) Control of self-reactivity in B lymphocytes. 2. The major surface molecules associated with activation and subpopulations of B lymphocytes. To be familiar with The subpopulations and functions of B lymphocytes, the cytokines secreted by B lymphocytes. Course Contents 1. Development, derivation and maturation of B lymphocytes 1) B lymphocyte differentiation 2) Ig gene rearrangement. 2. Control of self-reactivity in B lymphocytes 3. Antibody affinity maturation 4. Surface molecules of B lymphocytes 1) BCR: structure and characteristics of antigen recognition 2) Ig/Ig complex: structure and function 3) Co-receptor (CD19/CD21/CD81): structure and function 4) Co-stimulator molecules (B7): ligand and function 5) Adhesion molecules: classes and functions 6) Mitogen receptors: LPS and PWM receptors 7) Other CD molecules (CD20 and CD40): ligands and functions 5. Subpopulations of B lymphocytes 108

1) B1 cells: phenotype and functions 2) B2 cells: phenotype and functions 6. Functions of B lymphocytes 1) Production of antibodies 2) Antigen presentation 3) Regulation of immune responses

Chapter 14. Innate immune response Objective 1. Master the components involved in innate immune response. Master the relationship between innate immune response and adaptive immune response. 2. Understand the recognition mechanism of innate immune response. 3. Know the biological significance of innate immune response. Course Contents 1. Components involved in innate immune response 1) Skin and mucosal surfaces. 2) Immune cells involved in innate immune response. 3) Humoral proteins of innate immunity. 2. Recognition mechanism of innate immune response 1) Pathogen associated molecular patterns 2) Pattern recognition receptors. 3. Biological significance of innate immune response.

Chapter 15 . Antigen presentation Objective 1. Master the Class I and Class II antigen presentation pathway. 2. Understand the cross presentation of antigen. 3. Know the concept of antigen presentation and antigen presenting cells (APCs). Know the properties of APCs. Course Contents 1. The concept of antigen presentation 1) The concept of antigen processing and presentation 109

2) The nature of antigens to be presented 3) Endogenous and exogenous antigens 2. The Antigen Presenting Cells (APCs) 1) Professional APCs: Classes of professional APCs and Properties of professional APCs 2) Non-professional APCs: Classes of non-professional APCs 3. The Class I antigen presentation pathway 4. The Class II antigen presentation pathway

Chapter 16. and 17. T/B cell responses Objective 1. Master the characteristics of antigen recognition by TCR and BCR. Master the mechanism of CD8+T cell activation. Master the roles of cell-mediated immunity and humoral immunity. 2. Understand the concept of the immune response. Understand the mechanism of CD4+T cell activation. Understand the mechanism of B cell activation. Understand the mechanism of cytotoxicity mediated by CTL. Understand the primary and secondary response. 3. Know proliferation and differentiation of activated T and B cells. Course Contents 1. The concept of the immune response 2. An overview of an immune response 3. The humoral immune response 1) The cells involved and their effects 2) The effects of APC in a humoral response 3) The course of humoral immunity 4. CD4+T cell-mediated response 1) Cell types involved and their effects 2) The course of CD4+T cell mediated immunity 5. CD8+T cell-mediated response 1) Types of cells involved and their effects 2) The course of CD8+T cell mediated immunity 6. Biological effects of cell-mediated immunity and humoral immunity in an individual.

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Chapter 18. Immune Regulation Objective 1. Master the regulation role of regulatory T cells. Master the concepts of ITAM, ITIM and AICD. 2. Understand the active receptors and suppressing receptors on the immune cells. Understand the idiotype network. 3. Know the regulation role of antigen, antibody and complement. Know the regulation relationship between neuroendocrine system and immune system. Course Contents 1. Regulation role of antigen, antibody and complement. 2. Regulation role of signaling components and suppressing receptors on the immune cells. 3. Regulation role of T cells and the idiotype network. 4. Neuroendocrine immune system regulation.

Chapter 19. Immune tolerance Objective At the end of the course, the students should be able to: 1. Master the concepts of central tolerance and peripheral tolerance. 2. Understand the mechanisms of Immune tolerance. 3. Know the establishment and abrogation of Immune tolerance. Course Contents 1. the development and representation of Immune tolerance 1) Innate tolerance 2) Acquired tolerance 2. Mechanisms of immune tolerance 1) Central tolerance 2) Peripheral tolerance 3. Immune tolerance and clinical medicine 1) Establishment and maintenance of Immune tolerance 2) Abrogation of immune tolerance

Chapter 20. Hypersensitivity 111

To master Concept of hypersensitivity and Classification. Mediators and mechanism of Type I- Type IV, example of hypersensitivity in each type. To be familiar with Therapy for Type I Hypersensitivity, Arthus reaction, Delayed-type Hypersensitivity (DTH). To understand Immune complex disease (ICD), Arthus reaction, Nephritis, Tuberculin test, Drug reactions. Course Contents 1. Concept of hypersensitivity. Hypersensitivity: Gell and Coombs Classification. Mediators and mechanism of Type I Hypersensitivity, Type I Hypersensitivity associated diseases (Allergic Rhinitis, Asthma, Food allergies, Atopic dermatitis, etc). Mast cell activation and degranulation, the biological effects of histamine in allergic reactions, therapy for Type I Hypersensitivity. 2. Three different effector mechanisms in Type II Hypersensitivity, Type II Hypersensitivity associated diseases (Hemolytic disease of the newborn, blood transfusion reaction, Drug-induced cytotoxic reactions, etc). Graves disease, Goodpasture’s syndrome. 3. Circulating Immune Complexes and Pathogenesis in Type III Hypersensitivity, Type III Hypersensitivity associated diseases (Systemic lupus erythematosus (SLE), Rheumatoid arthritis, Poststreptococcal glomerulonephritis, etc). Arthus reaction , Immune complex disease (ICD), Arthus reaction, Serum sickness, Nephritis, Myasthenia Gravis, Farmers lung, Multiple Sclerosis (MS). 4. Delayed-type Hypersensitivity (DTH), Immune Pathogenesis in Type IV Hypersensitivity, Type IV Hypersensitivity associated diseases (Contact Dermatitis, Insulin-dependent diabetes mellitus (IDDM), etc). Tuberculin test, Drug reactions.

Chapter 23. Tumor Immunology To master Concept of tumor antigen, mechanism of anti-tumor effects and mechanism of tumor escape. To be familiar with Tumor Immunotherapy, immune privilege, tumor vaccines. Course Contents 1. Concept of tumor antigen, tumor-specific antigen (TSA), tumor-associated antigen (TAA); 112

Comprehend: cancer-testis Ag. 2. Mechanism of Anti-tumor Effects, humoral and cellular immunity. Mechanism of tumor Escape. 3. Antigen modulation, immune privilege, Fas/FasL counterattack, Tumor Immunotherapy. 4. Tumor Immunodiagnosis, tumor-associated macrophages (TAMs), cancer stem cells (CSCs) or tumor stem cells (TSCs), tumor vaccines.

Ⅱ. The Syllabus of Immunological Experiments Agglutination Reaction Skills 1. Master the principles of the agglutination reaction 2. Be familiar with the technique of how to do an agglutination experiment 3. Know how to observe and give the results of the slide agglutination test and tube agglutination test. Experiments 1. The classification and principle of the agglutination reaction. 2. The application of an agglutination experiment. 3. Direct Agglutination Reaction -- Slide Agglutination Test (Experiment 1). 4. Direct Agglutination Reaction -- Tube Agglutination Test (Experiment 2).

Precipitation Reaction: Skills 1. Master the principles of a precipitation reaction. 2. Be familiar with the technique of how to do a precipitation experiment. 3. Know how to analyze the results. Experiments 1. The classification and principle of the precipitation reaction. 2. The application of a precipitation experiment. 3. Double Radial Immunodiffusion Test (Experiment 3). 4. Countercurrent Electrophoresis Test (Experiment 4).

Immunolabeling Techniques: 113

Skills 1. Master the principles and classification of ELISA. 2. Be familiar with the techniques and applications of ELISA. 3. Know the classification and principles of the immunolabeling technique. Experiment 1. The classification and principles of the immunolabeling technique. 2. The principles and classification of ELISA. 3. The techniques and applications of ELISA. 4. The indirect Enzyme-Linked Immunosorbent Assay (Experiment 5)

Antigen and antibody reaction Involved by Complement: Skills 1. Master the principle of Hemolytic Assay Involved by Complement. 2. Be familiar with the technique of doing the hemolytic assay involved by complement. 3. Know how to analyze the results. Experiment 1. The principle of Hemolytic Assay Involved by Complement. 2. The application of Hemolytic Assay Involved by Complement 3. The technique of antigen and antibody reaction involved by complement (Experiment 6).

Separation of mononuclear cells from whole peripheral blood: Skills 1. Master the principles of cell separation. 2. Be familiar with the technique of separation of mononuclear cells from human peripheral blood by ficoll-hypaque density gradient centrifugation. 3. Know the stain and count of human PBMC. Experiment 1. The principle of separation of PBMCs from human peripheral blood by ficoll-hypaque density gradient centrifugation. 2. The technique of separation of PBMCs from human peripheral blood (Experiment 8). 3. Count the live PBMCs by typan blue with the blood-cell-counter under the microscope.

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Detection of T lymphocyte by erythrocyte rosette forming test Skills 1. Master the principle of the E rosette test for T lymphocytes. 2. Be familiar with the method of detection of the T cells. 3. Know the various methods for T cells detection. Experiment 1. The principle and technique of the Erosette test (Experiment 9). 2. Observe rosette forming cell under the microscope. 3. Calculate the percentage of rosette-forming cells. 4. Other methods for T cell detection, such as FACS and MACS.

Measurement of phagocytosis by phagocytes Skills 1. Be familiar with the technique of how to measure phagocytosis. 2. Know the calculation and application of the percentage of phagocytosis. Experiment 1. The principle and method of phagocytosis (Experiment 10). 2. Observe phagocytosis under the microscope. 3. Calculate the percentage of phagocytosis.

Detection of B lymphocyte by PE-conjugated anti-IgM staining Skills 1. Master the principle of fluorescence-labeled antibody staining with cells. 2. Be familiar with the technique of immune cells surface staining with fluorescence-labeled antibody. 3. Know the application of flowcytometry assay.

Experiment 1. The principle of immune cells surface staining with fluorescence-labeled antibody. 2. Technique of cell surface staining with fluorescence-labeled antibody. 3. 3. Detection of B lymphocyte by PE-conjugated anti-IgM staining (Experiment 11) 4. Application of flowcytometry assay. 115

Ⅲ. Hours Distribution

Content Lecture Discuss Lab 48 16 Section 1: Fundaments of Immunology 6 Section 2: Brief history and prospect Section 3: Antigen 6 Section 4: Immunoglobulins Section 5: Complement system 3 Section 6: Cytokines Section 7: MHC; 3 Section 8: CD Section 9: Hematopoietic stem cells 3 Section 10: Cells of Innate Immunity 6 Section 11: T lymphocytes Section 12: B lymphocytes 6 Section 14: Innate immune response Section 15: Antigen presentation 6 Section 16, 17: T/B cell responses Section18,19: Regulation/ tolerance 6 Section 20: Hypersensitivity Section 21: Tumor Immunology 3 Experiment 1 Detection of Innate Immunity 3 Experiment 2 Detection of antigen and antibody 6 Experiment 3 Detection of T lymphocytes 3 Experiment 4 Detection of B lymphocytes 2 Examination of experiment 2

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Ⅳ. Assessment Classroom attendance 5% Classroom quizzes 5% Laboratory attendance 5% Experiment report 10% Experiment examination 5% Final Test 70% Total 100%

Ⅴ.Textbook and references Textbook Tristram G. Parslow Medical Immunology Technology Publishing House March, 2006 Reference Books 1. Guangyan Zhou Principles of Immunology Shanghai Science and Technology Publishing House April, 2007 2. Peter Lydyard Immunology Technology Publishing House August, 2009 3. Xuetao Cao Leading edge progression of Immunology The People's Medical Publishing House December, 2009 Journals 1. Journal of Immunology USA 2. Immunology Letters Newzland

117

Human Parasitology

Credits: 3 Total hours: 56 Lectures hours: 40 Experiment hours 16 Grade: 2nd Semester: 2 Y Rui-Li ang Feng-Shu Zhao Compilers: Email: [email protected]

Ⅰ. Preamble and Objectives Human Parasitology is the study of those species of the animal kingdom that cause disease in human beings. The teaching target of human parasitology is helping medical students to grasp the morphological features, life cycle and main harm of the parasites to human beings and vector-arthopods, to master the basic technology of common parasite examination and to establish foundation for clinical medicine, preventive medicine and the control of parasitic diseases.

Ⅱ. Contents and Requirements： Introduction To master 1. Common terms about parasite: host, intermediate host, final host, reservoir host, paratenic host, life cycle, infective stage, zoonosis. 2. Host-parasite relations. To be familiar with 1. The characteristics and functions of immunity to parasitic infection. 2. The epidemic links, factors and charactersistics of parasitic diseases. To understand 1. The scope of Human Parasitology, classification of parasites and characteristics of parasitic nutrition and metabolism. 2. The characteristics of parasitic infection and diseases 3. The diagnosis of parasitic diseases and prevention and treatment principle of parasitic

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diseases. 4. The current situation of parasitic diseases, progress, achievements of prevention and treatment of parasitoses. Introduction to Medical Protozoa To master the concept of protozoa, alternation of generation, trophozoite, cyst and characteristics of morphology, physiology, life cycle and pathogenesis of medical protozoa. To understand the classification of medical protozoa.

Chapter 45 . Lobosea Section 1. Entamoeba Histolytica To master 1. The morphology of Entamoeba histilytica cyst, life cycle, pathogenicity of E. histilytica, clinical features, clinical form of amoebiasis, pathogenic diagnosis for amoebiasis, the drug for amoebiasis. 2. The morphological differentiation between E. histilytica and E. coli cysts. To be familiar with The morphology of E. histilytica trophozoite. The epidemiological features and preventive treatment principles. To understand The molecular biological diagnostic techniques and immunological diagnostic techniques for amoebiasis, the other non-pathogenic amoebae and free living amoebae.

Chapter 46. Zoomastigophorea Section 1. Trichomonas vaginalis To master The life cycle, pathogenicity, clinical features, pathogenic diagnosis and the drug for trichomoniasis. To be familiar with The morphology of the trophozoite. To understand 119

The molecular biological diagnostic techniques and immunological diagnostic techniques for trichomoniasis. Section 2. Giadia Lamblia To master The life cycle, pathogenicity, clinical features, pathogenic diagnosis and drug for giardiasis. To be familiar with The morphology of the trophozoite and cyst. To understand The molecular biological diagnostic techniques and immunological diagnostic techniques for giardiasis. Section 3. Leishmania To master The life cycle, pathogenicity, clinical features, pathogenic diagnosis and drug for leishmaniasis. To be familiar with The morphology of the amastigote and promastigote. To understand The molecular biological diagnostic techniques and immunological diagnostic techniques for leishmaniasis.

Chapter 47 . Sporozoa Section 1. Plasmodia To master The life cycle, pathogenicity, clinical features, pathogenic diagnosis and the immunity against plasmodia. To be familiar with The morphology of the trophozoite and cyst, the antimalarial drug. To understand The molecular biological diagnostic techniques and immunological diagnostic techniques for malaria. Section 2. Toxoplasma gondii To master The life cycle, pathogenicity, clinical features, pathogenic diagnosis and opportunistic parasite. 120

To be familiar with The morphology of the trophozoite, cyst and oocyst. The details of the clinical manifestations; The treatment for toxoplasmosis. To understand The molecular biological diagnostic techniques and immunological diagnostic techniques for toxoplasmosis. The epidemiology of toxoplasmosis and prevention of toxoplasmosis. Section 3. Cryptosporidium To master The life cycle, pathogenicity, clinical features, pathogenic diagnosis and opportunistic parasite. To be familiar with The morphology of the oocyst; the details of the clinical manifestations. To understand The molecular biological diagnostic techniques and immunological diagnostic techniques for cryptosporidiosis. The epidemiology of cryptosporidiosis. The treatment and prevention of cryptosporidiosis. Section 4. Pneumocystis jirovecii To master The life cycle, pathogenicity, clinical features, pathogenic diagnosis and opportunistic parasite. To be familiar with The morphology of the oocyst. The details of the clinical manifestations. To understand The molecular biological diagnostic techniques and immunological diagnostic techniques for cryptosporidiosis. The epidemiology of cryptosporidiosis. The treatment and prevention of cryptosporidiosis.

Part VI. Helminthology Chapter 49. Trematodes Section 1. Introduction To master The common characteristics of trematoda in life cycle, pathogenesis and clinical features. To understand The morphological characteristics of trematoda. 121

Section 2. Clonorchis sinensis To master The characteristics of life cycle, pathogenesis, clinical features and pathogenic diagnosis. To be familiar with The morphological characteristics of adult and egg. The details of the clinical manifestations. To understand The epidemic factor and preventive principles of clonorchiasis. Section 3 . Paragonimus spp. To master The characteristics of life cycle, the clinical type and pathogenic diagnosis. To be familiar with The morphology of adult and egg, the pathology of paragonimiasis (suppurative stage, cystic stage, fibrous-scar stage), the lobed ovary and coiled uterus lie side by side; two lobed testes also lie side by side. The details of the clinical manifestations. To understand The epidemic factor and preventive principles of paragonimiasis. Section 4. Schistosoma japonicum To master The characteristics of life cycle of Schistosoma japonicum, the mechanism of pathogenesis of Schistosomiasis (granuloma formation surrounding eggs), the clinical types, and pathogenic diagnosis. To be familiar with The morphology of adult and egg of Schistosoma japonicum. The details of the clinical manifestations. To understand The epidemic factor and preventive principles of Schistosomiasis. Section 5 Fasciolopsis buski To master The characteristics of life cycle, the pathogenesis, clinical features and pathogenic diagnosis. To be familiar with The morphology of adult and egg. The details of the clinical manifestations. To understand 122

The epidemic factor and preventive principles of fasciolopsiasis.

Chapter 50. Cestodes Section 1. Introduction To master The common characteristics of cestoda in life cycle. To be familiar with The morphological characteristics of cestoda. To understand The classification of cestodes. Section 2. Taenia solium To master The characteristics of life cycle, the pathogenesis, clinical type and pathogenic diagnosis. To be familiar with The morphological characteristics of adult, cysticercus cellulosae and eggs. The details of the clinical manifestations. To understand The epidemic factor and preventive principles of taeniasis and cysticercosis. Section 3 Tenia saginata To master The characteristics of life cycle, the pathogenesis，clinical features and pathogenic diagnosis (compared with T. solium.). To be familiar with The morphological characteristics of adult: compared with T. solium. The details of the clinical manifestations. To understand The epidemic factor, preventive principles and treatment of Taenia saginata infection. Section 4. Echinococcus granulosus To master The characteristics of life cycle, pathogenicity, clinical features, pathogenic diagnosis. To be familiar with 123

The morphological characteristics of adult and hydatid cyst. The details of the clinical manifestations. To understand The molecular biological diagnostic techniques and immunological diagnostic techniques for hydatidosis. The epidemiology of hydatidosis. The treatment and prevention for hydatidosis. Section 5. Spirometra mansoni To master The characteristics of life cycle, the pathogenesis, clinical type and pathogenic diagnosis. To be familiar with The morphological characteristics of adult and sparganum. The details of the clinical manifestations of sparganosis mansoni. To understand The epidemic factor, treatment and preventive principles of sparganosis mansoni.

Chapter 51. Nematode Section 1. Introduction To master The characteristics and patterns of the life cycle of nematodes: soil-born nematodes and organism–born nematodes. To be familiar with The morphological characteristics of nematodes. To understand The classification of nematodes. Section 2. Ascaris lumbricoides To master The characteristics of life cycle, the pathogenesis, clinical type (Ascaris pneumonia, intestinal ascariasis) and pathogenic diagnosis. To be familiar with The morphological characteristics of Ascaris adults and eggs. The details of the clinical manifestations. To understand The epidemiological factors, preventive and treatment principles of Ascaris infection. 124

Section3. Trichuris trichiura (whipworm) To master The features of life cycle, pathogenesis and pathogenic diagnostic methods of whipworm infection. To be familiar with The morphological characteristics of whipworm adults and eggs. The details of the clinical manifestations. To understand The epidemiological factors, preventive and treatment principles of whipworm infection. Section 4. Enterobius vermicularis ( pinworm) To master The features of life cycle, pathogenesis and pathogenic diagnostic methods of pinworm infection. To be familiar with The morphological characteristics of pinworm adults and eggs. The details of the clinical manifestations. To understand The epidemiological factors, preventive and treatment principles of pinworm infection. Section5. Ancylostoma duodenale and Nector americanus (hookworm) To master The features of life cycle, pathogenesis and pathogenic diagnostic methods of hookworms. To be familiar with The morphological features of hookworm eggs and the identification point of two hookworm adults. The details of the clinical manifestations. To understand The epidemiological factors, preventive and treatment principles of hookworm infection. Section6 . Wuchereria bancrofti and Brugia malayi ( Filaria ) To master The features of life cycle, pathogenesis, clinical features and the pathogenic diagnostic methods of lymphatic filariasis. To be familiar with The morphological features and the identification point of microfilaria bancrofti and microfilaria malayi. The details of the clinical manifestations of lymphatic filarial infection. To understand 125

The epidemiological factors, preventive and treatment principles of lymphatic filarial infection.

Part VII. Medical Arthropodology Chapter 52 . Introduction To master The characteristics of medical arthropods, the classification of medical arthropods, the harmful effects of arthropods to human health, the principles of controlling the medical arthropods, the concept of mechanical transmission, biological transmission, metamorphosis, complete metamorphosis and incomplete metamorphosis. To be familiar with The characteristics of Insecta and Arachnoidea. To understand The details of controlling vector-arthopods.

Mosquitoes To master The diseases transmitted by mosquitoes. To be familiar with The life cycle. To understand The ecological behaviors, the prevention and control.

Fly To master The diseases transmitted by flies and the transmission patterns. To be familiar with The life cycle. To understand The ecological behaviors, the prevention and control.

Itch mite To master 126

The location of itch mite; the disease caused by itch mite; the pathogenic diagnosis of scabies. To be familiar with The life cycle, the prevention and treatment. To understand The morphology of itch mite. Follicle mite To master The location of itch mite; the disease caused by itch mite; the pathogenic diagnosis. To be familiar with The life cycle, the prevention and treatment. To understand The morphology of itch mite.

Ⅲ.Hours Distribution

Time Content Time Content 2 Introduction of parasitology Chapter 44 general properties of the protozoa 3 Chapter 45 lobosea Section 1 entamoeba histolytica Chapter 46 zoomastigophorea Section 1 trichomonas vaginalis 3 Section 2 giardia lamblia Section 3 leishmania Chapter 47 sporozoa Section 2 toxoplasma gondii 3 Section 3 cryptosporidium Section 4 pneumocystis carinii 3 Section 1 plasmodia

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Chapter 48 ciliates Part VI helminthology 3 Chapter 49 trematodes Section 1 introduction Section 2 clonorchis sinensis Section 3 paragonimus spp. 3 Review Section 4 schistosoma 3 Section 5 Fasciolopsis Buski, Chapter 50 cestodes Section 1 Introduction of cestodes, 3 Section 2 Taenia solium, Section 3 Taenia saginata Section 4 Echinococcus granulosus, 3 Section 5 spirometra mansoni Chapter 51 Nematoda Section 1 Introduction of Nematoda Experiment 1 3 Section 2 Ascaris, 4 Nematoda, Section 3 trichiura, Section 5 Enterobius Experiment 2: Section 4 Hookworms, 3 4 Trematodes, Section 6 Filariae（1） cestodes Section 6 Filariae（2） Chapter 52 Arthropoda Experiment3: 3 Introduction of Arthropoda 4 protozoa 1 Chapter 53 Insecta Introduction of Class Section 2 Mosquitoes, Experiment4: Section 3 flies 2 4 protozoa2, Chapter 54 Arthropoda Sarcoptes, Demodex 2 Test

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Ⅳ. Assessment Attendance and Performance 10% Experiment 10% Mid-term exam 40% Final Test 40% Total 100%

Ⅴ. References Reference Books 1. Bogitsh BJ, Cheng TC: Human Parasitology. 2nd ed. USA: Academic Press,1998; 2. Markell JK: Medical Parasitology. 8th ed. Philadelphia: W. B. Saunders Company, 1999. Journals 1. Parasitology Today (Trends in Parasitology) 2. Acta Tropica Useful web sites 1. http://www.med.sc.edu 2. http://www.parasitology-online.com 3. http://www.ebi.ac.uk/parasites/parasite-genome.html 4. http://www.ebi.ac.uk/blast2/parasites.html 5. http://parasite.vetmed.ufl.edu 6. http://www.mic.ki.se 7. http://www.dpd.cdc.gov 8. http://www.ncbi.nlm.nih.gov 9. http://www.who.int/tdr 10. http://www.who.int/programmes/tdr 11. http://www.biosci.ohio-state.edu/~parasite 12. http://www.ksu.edu/parasitology 13. http://www.keele.ac.uk/depts/aep 14. http://www.life.sci.qut.edu.au/LIFESCI/darben/paramast.htm 15. http://www.biosci.ohio-state.edu/~parasite/home.html

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Pathophysiology

Credits: 4 Total hours: 80 Lectures hours: 48 Experiment hours 32 Grade: 2nd Semester: 2 Wei-Ping Yu Chuan-Lu Shen Compilers: Kai Liao Email: [email protected]

Ⅰ.Course Description This course is designed to present an orientation to diseases as disordered physiology. It is intended to enable high-grade medical students to understand why and how various common pathological processes as well as physical symptoms and signs of such conditions appear. In approaching disease as disordered physiology, this course analyzes the etiology and the mechanism(s) of production of the pathological processes including the symptoms and signs of them. In doing so, it recognizes the student’s need to understand the mechanism(s) underlying the disease and its clinical manifestations so that rational therapies can be devised. Thus, appropriate diagnostic laboratory evaluation indexes will also be included. This course also provides the results of advanced in-depth study of human pathological processes and their effects on homeostasis. The course has been approved as a major course for medical students in Medical School of Southeast University.

Ⅱ. Course Objectives At the completion of this course, the high-grade medical students should possess a well-grounded understanding of normal physiological and pathological mechanisms underlying the disease and its clinical manifestations that will serve as one primary component of the foundation for clinical assessment, decision making and management. The students should be able to relate this knowledge to interpreting changes in normal function that result in symptoms indicative of illness and in assessing a patient’s response to pharmacological management of illness. The students will have the knowledge and skills to synthesize and apply current 130

research-based knowledge regarding the pathological processes in patients; to understand the differences between physiological function and pathological processes in various systems of the body; to describe the etiology, pathogenesis, and clinical manifestations of commonly found/seen altered health states; to develop basic critical thinking skills to analyze the clinical manifestations based on the underlying pathological processes of illnesses and diseases.

Ⅲ. Contents and Requirements There are three levers for learning requirements which are described with "to master", "to be familiar with" and "to understand" as beginning respectively in an order according to their relative importance. Chapter 1. Introduction of Pathophysiology & Chapter 2. Conspectus of Diseases To master The concepts of health, disease, etiology, and conditions; and to master the concept of brain death with its criteria for diagnosis. To be familiar with Content of pathophysiology, the classification of etiology, the common laws and the basic mechanisms involved in the occurrence and the development of diseases. To understand The role of the pathophysiology course in medical education. To know the main methods applied in pathophysiological research and the history of origination and development of pathophysiology.

Chapter 3. Disorders of Water and Electrolyte Metabolism To master 1. the definition of dehydration including hypotonic dehydration, hypertonic dehydration and isotonic dehydration, the alteration of metabolism and function of hypotonic dehydration and hypertonic dehydration; 2. the definition of edema and its pathophysiological mechanisms; 3. the definition of hypokalemia and hyperkalemia, the alteration of metabolism and function (especially nerve-muscle and heart) in hypokalemia and hyperkalemia. To be familiar with 1. the classification of disorders of water and sodium metabolism; 131

2. the etiology and the mechanism(s) of hypotonic dehydration, hypertonic dehydration and isotonic dehydration; the alteration of metabolism and function of isotonic dehydration; 3. the characteristics of edema and the effects of edema on the body; 4. the etiology, the mechanism(s) and the principles for prevention and treatment of hypokalemia and hyperkalemia. To understand 1. the normal regulation of body fluid and electrolyte metabolism; 2. the definition of water intoxication and its influence on body, especially the influence of cellular edema on brain; 3. the principles for treatment of different kinds of dehydrations; 4. the normal regulation of potassium metabolism.

Chapter 4. Acid-base Balance and Imbalance To master 1. the concept and types of acid-base imbalance; 2. the concept of four kinds of simple acid-base disorders and the concept of mixed acid-base disorders; 3. the classification, the etiology and the mechanism(s) of metabolic acidosis, the compensatory regulation of the body and the alteration of metabolism and function of metabolic acidosis; 4. the classification, the etiology and the mechanism(s) of respiratory acidosis, the compensatory regulation of the body and the alteration of metabolism and function of respiratory acidosis. To be familiar with 1. the main indexes reflecting the acid-base balance, including pH, arterial partial pressure of carbon dioxide, standard bicarbonate, actual bicarbonate, buffer excess, buffer base and anion gap, and their significance; 2. the classification, the etiology and the mechanism(s) of metabolic alkalosis, the compensatory regulation of the body and the alteration of metabolism and function of metabolic alkalosis; 3. the classification, the etiology and the mechanism(s) of respiratory alkalosis, the compensatory regulation of the body and the alteration of metabolism and function of respiratory alkalosis; 4. the basic method of analysis to determine the acid-base balance disorders. To understand 132

1. normal acid-base balance and its regulation; 2. the classification, the etiology and characteristic of mixed acid-base balance disorders; 3. the principles based on pathophysiological theory for treatment of acid-base imbalance.

Chapter 5. Hypoxia To master 1. the concept of hypoxia，cyanosis, enterogenous cyanosis; 2. the classification of hypoxia and the definition of each type of hypoxia; 3. the etiology, mechanisms and characteristics of blood oxygen of each type of hypoxia. To be familiar with 1. the parameters of blood oxygen and their significance; 2. functional and metabolic changes of respiratory system, circulation system, blood system and tissue cells in hypoxia. To understandthe Principles based on pathophysiological theory for treatment of each type of hypoxia.

Chapter 6. Fever To master 1. the concept of fever, hyperthermia, endogenous pyrogen; 2. the "set point" theory and the pathogenesis of fever; 3. phases of fever and their characteristics of temperature regulation. To be familiar with the functional and metabolic changes of body in fever. To understand: 1. the classification of exogenous pyrogen, endogenous pyrogen and chemical febrile mediators; 2. the principles based on pathophysiological theory for treatment of fever.

Chapter 7. Shock To master 1. the concept of shock; 2. the process of development of shock: the "microcirculatory theory" and three stages of a 133

typical shock; 3. the pathogenesis of three stages of shock. To be familiar with 1. the causes and categories of shock; 2. the cellular damage and metabolic disorders in shock, the concept of shock cell; 3. dysfunction of vital organs and its mechanisms. To understand 1. the changes of humoral factors in shock; 2. the principles based on pathophysiological theory for prevention and treatment of shock.

Chapter 8. Heart Insufficiency To master 1. the concepts of cardiac insufficiency and heart failure; 2. the etiology and pathogenesis of heart failure; 3. the cardiac compensatory mechanisms in heart failure and their significance. To be familiar with 1. the classification and predisposing factors of heart failure; 2. systemic compensatory mechanisms in heart failure and their significance; 3. physiological and metabolic alterations of body in heart failure To understand 1. the molecular basis of normal myocardial systole and diastole; 2. the principles based on pathophysiological theory for prevention and treatment of heart failure.

Chapter 9. Respiratory Failure To master 1. the concepts of respiratory failure including both type I and type II respiratory failure; 2. the causes and pathogenesis of respiratory failure. To be familiar with 1. the classification of respiratory failure; 2. the concept and pathogenesis of acute respiratory distress syndrome (ARDS); 3. main alterations of metabolism and function during respiratory failure. 134

To understand 1. the concept and pathogenesis of Chronic Obstructive Pulmonary Disease (COPD); the principles based on pathophysiological theory for prevention and treatment of respiratory failure.

Chapter 10. Hepatic Encephalopathy To master 1. the concepts of hepatic insufficiency, hepatic failure, hepatic encephalopathy; 2. the ammonia intoxication hypothesis of hepatic encephalopathy; 3. the false neurotransmitter hypothesis of hepatic encephalopathy; 4. the amino acid imbalance hypothesis of hepatic encephalopathy; 5. predisposing factors of hepatic encephalopathy. To be familiar with 1. the etiology and classifications of hepatic encephalopathy; 2. the GABA hypothesis of hepatic encephalopathy; 3. effects of other neurotoxins on hepatic encephalopathy. To understand 1. the concept, etiology, classification and mechanism(s) of hepatorenal syndrome; 2. the principles based on pathophysiological theory for prevention and treatment of hepatic encephalopathy.

Chapter 11. Renal Failure To master 1. the concept and classification of renal failure; 2. the concept and classification of Acute Renal Failure (ARF); 3. the oliguric mechanism for oliguric ARF and alterations of metabolism and functions in the body; 4. the stages of oliguric ARF; water and electrolyte disorders, metabolism and acid-base imbalance in ARF; 5. the concepts of chronic renal failure (CRF) and uremia, the mechanism of CRF. To be familiar with 1. the etiology of ARF; 135

2. the mechanism and characteristics of nonoliguric ARF; 3. the etiology and stages of CRF; 4. water and electrolytic disorders, acid-base imbalance and the alterations of metabolism, and function of various systems in CRF. To understand 1. the pathogenesis and functional and metabolic changes of uremia; 2. the principles based on pathophysiological theory for prevention and treatment of ARF, CRF and uremia.

Ⅳ. Practice Requirements No medical education would be completed without exploring and approaching the body with diseases in a comprehensive manner, using the animal model. Therefore, several animal experiments have been designed for the students to perform to improve their understanding of pathophysiological knowledge. Throughout this learning experience, the education is also stressed through cooperation and collaboration -- not through competition -- and ongoing development of the ability to work with groups of colleagues and co-workers.

Experiment 1. Analysis of Edema Related Factors Experimenta l . Purpose 1. To replicate the animal model of edema. 2. To observe the effects of capillary hydrostatic pressure and colloid osmotic pressure in blood vessel on the formation of edema. 3. To discuss the mechanisms underlying the effects observed.

Experiment 2. Hypoxia Experimental Purpose 1. To replicate the animal models of hypoxia and to know the classifications of hypoxia. 2. To observe the changes including breath, color of skin and mucous membrane, and animal activity in each model of the different types of hypoxia. 3. To discuss the mechanisms underlying the changes of breath and tissue color in different types of hypoxia according to the experimental results.

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Experiment 3. Hepatic insufficiency Experimental Purpose 1. To replicate the animal models of acute hepatic failure and hepatic encephalopathy. 2. To observe the effect of increased blood ammonia concentration on the function of the brain. 3. To discuss the mechanisms underlying the pathogenesis and treatment of hepatic encephalopathy after creation of animal model of acute hepatic failure.

Ⅴ. Ability Training Requirements Upon completion of this course, students will be able to: (1) enhance their learning ability: they can master the basic knowledge of pathophysiology, understand the mechanisms underlying the occurrence and development of the commonly found/seen pathological processes and clinical syndromes, lay a solid foundation for further clinical medicine courses; (2) enhance their self-learning ability: they will have interests in learning and in reading medical literature to expand their field of medical knowledge; (3) enhance their creative ability: the students can analyze and solve problems independently; they are encouraged to think, to question and to answer by in-depth research.

Ⅵ. Hours Distribution Content Lecture Experiment Chapter One Introduction of Pathophysiology 1 Chapter Two Conspectus of Diseases 2 Chapter Three Disorders of water and electrolyte 6 8 metabolism Chapter Four Acid-Base Balance And Disturbances 5 Chapter Five Hypoxia 3 8 Chapter Six Fever 3 Chapter Seven Shock 4 Chapter Eight Heart Insufficiency 6 Chapter Nine Respiratory Failure 6 Chapter Ten Hepatic encephalopathy 6 8 Chapter Eleven Renal Failure 6

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Ⅶ. Assessment Attendance and Performance 10% Quizzes 10% Final Closed Book Test 80% Total 100%

Ⅷ. Textbook and references Textbook McPhee S. J., Lingappa V. R., & Ganong (2003). Pathophysiology of Disease (4th ed.) the McGraw-Hill Companies, Inc. ISBN 0-07-138764-1. Reference Books 1. Porth, C., & Matfin, G. (2009). Pathophysiology: Concepts of Altered Health States (8th Edition). Lippincott, Williams and Wilkins. ISBN 978-0-7817-6616-6. 2. Huether, S. E., & McCance, K. L. (2004). Understanding Pathophysiology (4th ed.) St. Louis, MO: Mosby Elsevier. Journals The New England Journal of Medicine is one of the most widely circulated journals, there is a special section in the journal titled “Clinical Problem-Solving.” In this feature, information about a real patient is presented in stages (including all of the pathophysiology) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader. This is followed by the author’s commentary. Students are suggested to read these articles in order to better appreciate the value of pathophysiology in one’s clinical training. 1. Doherty, D.E. (2004). The pathophysiology of airway dysfunction. Am J Med, 117 (Suppl 12A):11S-23S. 2. Hogg, J. C. (2004). Pathophysiology of airflow limitation in chronic obstructive pulmonary disease. Lancet, 364(9435):p709. 3. Lameire, N. (2005). The pathophysiology of acute renal failure. Crit Care Clin, 21(2):197-210. 4. Evans, K.J. (2005). Hyperkalemia: a review. J Intensive Care Med, 20(5):272-90

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Pathology

Credits: 2+1 Total hours: 144 Lectures hours: 80 Experiment hours 64 Grade: 3rd Semester: 1 Ping-Sheng Chen Compiler: Email: [email protected]

Preface Pathology is literally the study (logos) of suffering (pathos). More specifically, it is a bridging discipline involving both basic science and clinical practice and is devoted to the study of the structural and functional changes in cells, tissues, and organs that underlie disease. By the use of molecular, microbiologic, immunologic, and morphologic techniques, pathology attempts to explain the whys and wherefores of the signs and symptoms manifested by patients while providing a sound foundation for rational clinical care and therapy. Traditionally, the study of pathology is divided into general pathology and systemic pathology. The former is concerned with the basic reactions of cells and tissues to abnormal stimuli that underlie all diseases. The latter examines the specific responses of specialized organs and tissues to more or less well-defined stimuli. In the textbook, the authors first cover the principles of general pathology and then proceed to specific disease processes as they affect particular organs or systems. The four aspects of a disease process that form the core of pathology are its cause (etiology), the mechanisms of its development (pathogenesis), the structural alterations induced in the cells and organs of the body (morphologic changes), and the functional consequences of the morphologic changes (clinical significance). In order to help students study well, we have edited this outline, and hope it is read before class. --mainly cited from 8th edition of Basic Pathology

Convenient to students’ studying the course, the main contents of the curriculum are arbitrarily divided into three kinds: “master”, “be familiar with” and “understand” which expect

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different approaches from students. The “Master”- contents are the most essential and the most important contents, and students must be able to precisely memorize this category of contents and correctly paraphrase them. The “be familiar with”- contents are the main contents, and students must know this second kind of contents. The “understand”-contents belong to the general/common contents, and students only need to recognize and comprehend them.

Ⅰ.Contents and Requirements Introduction To be familiar with The concept of pathology, contents of pathology and its role in medical education. To understand Basic examination methods for pathology.

Part A - General Pathology Chapter 1. Adaptation and Injury of Cell and Tissue To master 1. The concepts and lesions of adaptation: atrophy, hypertrophy, hyperplasia, metaplasia. 2. The morphological changes of intracellular and extracellular accumulations in gross and light microscopic levels: hydropic degeneration, fatty change, hyaline change (connective tissue, vascular wall, intracellular). 3. The concepts of necrosis, and apoptosis. 4. The basic morphological evidence of necrosis (especially nuclear changes). 5. The morphological changes of main types of necrosis: coagulation, liquefaction, caseous necrosis, and fibrinoid necrosis. To be familiar with 1. Mucoid change, amyloid change, pathological pigmentation, and pathological calcification. 2. The significance of apoptosis in physiologic and pathologic conditions. To understand 1. The mechanisms and causes of injury of cell and tissue. 2. Fatty necrosis, gangrene; the mechanism of cellular aging. 140

Chapter 2. Tissue Repair To master The following definitions: regeneration, repair, and granulation tissue. To be familiar with 1. Progressive and fibrosis of granulation tissue. 2. The proliferative potential of different cell types, basic process of fracture healing. 3. The regeneration process of a variety of tissues (epithelial regeneration, regeneration of connective tissue and angiogenesis). To understand The mechanisms of cellular regeneration.

Chapter 3. Hemodynamic Disorders and Abnormalities of Blood Supply To master 1. The meanings or definitions of important terms in this chapter, such as congestion, heart failure cell, and thrombosis. 2. The concept, causes, and morphologic characteristics of edema, and describe ascites, hydrothorax and anasarca. 3. The concept, causes, pathological features, and effects of congestion, and describe the cause and pathological changes of liver and lung congestion. 4. The concept, etiology and pathogenesis of thrombosis (Virchow’s triad), and the types and consequences of thrombus. Compare the difference between thrombi and clots. 5. The concept and types of embolism and its influence on body. 6. The pathways of embolus travel. Name the most likely final destination of deep vein thrombosis. 7. The concept and types of infarction, and compare the morphologic characteristics of various types of infarction. To be familiar with 1. The concept and types of hyperemia. 2. Difference between hyperemia and congestion. To understand 1. The relationship among thrombosis, embolus and infarction. 2. Definitions of common types of hemorrhage. 141

Chapter 4. Inflammation To master 1. The meanings or definitions of important terms in this chapter, such as abscess, adhesion molecules, and granuloma. 2. The concept, basic pathological changes and consequences of inflammation. Name four cardinal signs of inflammation. 3. Process of chemotaxis, opsonization, and phagocytosis. 4. The types of inflammation and pathologic changes of different types of inflammation. Describe the morphologic characteristics and possible outcomes of the fibrinous and purulent inflammations. 5. The causes and morphologic characteristics of chronic inflammation including granulomas. To be familiar with 1. The vascular changes of acute inflammation and their relation to morphological and tissue effects. 2. The advantages and disadvantages of inflammatory exudates. 3. The characteristics and implications of various inflammatory cells. 4. The important inflammatory mediators. 5. The morphologic characteristics and possible outcomes of the fibrinous and purulent inflammations. 6. The granuloma and its types along with causes. 7. Compare acute and chronic inflammation. 8. The systemic effects of acute and chronic inflammation and their possible outcomes.

Chapter(s) 5. & 9. Neoplasia and the Malignancies of Hematopoietic and Lymphoid Systems To master 1. The meanings or definitions of important terms in this chapter, such as atypia, anaplasia, and dysplasia. 2. Concept and morphologic characteristics of neoplasm. 3. The general principles of neoplastic nomenclature and classification. List the common exceptions to standard terminology. 142

4. The growth and spread of neoplasm. Master the main routes of metastasis. Learn the mechanism of local invasion. 5. The grading and staging of tumors on body. 6. The difference between benign and malignant tumors. 7. The difference between carcinoma and sarcoma. To be familiar with Classification of lymphoid neoplasm and leukemia, and learn the features of the common types of lymphoma and leukemia. To understand 1. Local and systemic effects of tumors. 2. The etiology and pathogenesis of tumor and explain the role of oncogenes and tumor suppressor genes in the pathogenesis of tumor. 3. Tumor immunity. 4. Pathological features of common tumors.

Part B - Systemic Pathology Chapter 6. Diseases of Cardiovascular System To master 1. The pathologic character of atherosclerosis. 2. The location and frequencies of coronary atherosclerosis. 3. The morphologic features and complications of myocardial infarction. 4. The clinical features, the gross and microscopic morphology, and the complications of hypertension including the heart, central nervous system, kidneys, blood vessels. 5. The basic pathological changes of rheumatism. 6. The pathologic character of rheumatic pancarditis including endocarditis, myocarditis, and pericarditis. 7. The gross and microscopic morphology, clinical presentation and course of infective endocarditis. 8. The definition of atherosclerosis, fatty streaks, atheromatous plaque, myocardial infarction, ventricular aneurysm, hypertension, concentric hypertrophy, coronary heart disease, Aschoff body, rheumatic vegetations, chronic rheumatic heart disease, mitral stenosis, infective endocarditis. 143

To be familiar with 1. The etiology and pathogenesis of atherosclerosis. 2. The pathophysiology of valvular heart diseases. To understand 1. The etiology and pathogenesis of hypertension, rheumatism and infective endocarditis. 2. The conception and classification of myocarditis and cardiomyopathy.

Chapter 7. Diseases of Respiratory System To master 1. The etiology, pathological features, complications and the clinical features of lobar pneumonia, lobular pneumonia and viral pneumonia. 2. The definition of acute interstitial pneumonia. 3. The definition of COPD. 4. The pathological features, complications and clinical features of chronic bronchitis, emphysema, bronchial asthma, bronchiectasis, and silicosis. 5. The etiology, pathogenesis and pathological features of chronic cor pulmonale. 6. The etiology, classification, gross types, spread and clinical features of carcinoma of the lung. 7. The definition of consolidation, acute congestion, red hepatization, gray hepatization, bronchopneumonia, interstitial pneumonia, emphysema, panacinar emphysema, centriacinar emphysema, periacinar emphysema, bullous emphysema, bronchiectasis, chronic obstructive pulmonary disease, chronic bronchitis, asthma and silicosis. To be familiar with 1. Organize and be able to discuss the etiology, pathogenesis (the health condition of host), classification, and morphological lesions of pneumonia. 2. The features of the acute bacterial pneumonia. 3. The classification of emphysema. To understand 1. The structure of the respiratory system. 2. The manifestations of respiratory diseases. 3. The etiology, pathogenesis of chronic bronchitis, emphysema, bronchial asthma, bronchiectasis, and silicosis. 4. The etiology, pathogenesis, pathological features, and clinical features of SARS. 144

Chapter 8. Diseases of Digestive System To master 1. The types of chronic gastritis. 2. The pathological changes, outcome and complications of peptic ulcer diseases. 3. The predilection site, the naked eye morphology and the common histological type of digestive tract carcinoma (including esophageal carcinoma, gastric carcinoma, colorectal carcinoma) as well as the concept of the early carcinoma. 4. The basic pathological changes, pathological types, and clinical pathological relationship of hepatitis virus. 5. The gross and microscopic features, clinical pathological relationship of cirrhosis (such as portal hypertension and hepatic failure). 6. The types of gross morphology and histology, and diffuse characteristics of primary liver cancer. 7. The term explanations: early gastric carcinoma, leather-bottle stomach, piecemeal necrosis, bridging necrosis, cirrhosis of the liver. To be familiar with 1. The etiology and pathogenesis of peptic ulcer diseases. 2. Diffusion of digestive tract carcinoma (including esophageal carcinoma, gastric carcinoma, colorectal carcinoma). 3. Etiology and pathogenesis of viral hepatitis. 4. The etiology and pathogenesis of alcoholic liver disease and cirrhosis. To understand 1. The etiology, pathogenesis, pathological changes of reflux esophagitis. 2. The etiology and pathogenesis of digestive tract tumor and primary liver carcinoma.

Chapter 9. Diseases of Immunity To master 1. The features of systemic lupus erythematosus (SLE), rheumatoid arthritis including clinical presentation, morphology. 2. Vocabulary/Related Terms: Libman-Sachs endocarditis; wire loop lesions; pannus; rheumatoid nodules; hyperacute rejection; acute rejection; chronic rejection 145

To be familiar with The classification of transplant rejections and pathological changes. To understand The pathogenesis of transplant rejections.

Chapter 10. Diseases of the Urinary System To master 1. The definition of nephrotic syndrome and acute nephritic syndrome. 2. Basic histopathologic morphology and terms used in the diagnosis of renal glomerular diseases (focal vs. diffuse and segmental vs. global; histologic components of glomerulus, special stains, immunofluorescence studies). 3. The features of acute diffuse proliferative glomerulonephritis, chronic glomerulonephritis and pyelonephritis including clinical presentation, morphology and prognosis. 4. Vocabulary/Related Terms: 5. azotemia; uremia; oliguria; pyuria; hematuria; proteinuria; IgA nephropathy (Berger's disease); end stage kidney; Goodpasture's syndrome; crescent To be familiar with 1. The features of rapidly progressive (crescentic) glomerulonephritis, membranous glomerulonephritis (membranous nephropathy), minimal change disease (lipoid nephrosis), Focal segmental glomerulosclerosis, IgA nephropathy including clinical presentation, morphology and prognosis. 2. The features of renal cell carcinoma and urothelial carcinoma (transitional cell carcinoma) in the bladder including clinical presentation, morphology and prognosis. To understand 1. The basic mechanisms (or pathogenesis) of glomerular diseases including circulating immune complex, immune complex in situ, cell-mediated immune, epithelial cell injury. 2. Membranoproliferative glomerulonephritis morphology.

Chapter 11. Diseases of the Genital System and Breast To master 1. The features of cervical intraepithelial neoplasia (CIN), microinvasive squamous cell carcinoma, invasive carcinomas of the cervix, hydatidiform mole (complete and partial), 146

invasive mole, choriocarcinoma, and mammary carcinoma including epidemiology, morphology, clinical course and prognosis. 2. Vocabulary/Related terms: prostatic intraepithelial neoplasia (PIN); cervical intraepithelial neoplasia (CIN); microinvasive squamous cell carcinoma; prostrate-specific antigen (PSA); intraductal carcinoma; comedocarcinoma; lobular carcinoma in situ (LCIS); BRCA-l; BRCA-2; Peau d’orange; C-erb B2 protooncogene. To be familiar with Chronic cervicitis, benign prostatic nodular hyperplasia (BPH), adenocarcinoma of the prostate in terms of frequency, pathogenesis, clinical presentation, morphology, clinical course-complications and prognosis. To understand 1. Endometrial carcinoma, Uterine leiomyomas, and Leiomyosarcomas in terms of frequency, pathogenesis, clinical presentation, morphology, clinical course-complications and prognosis. 2. Ovarian tumors incidence, risk factors, classification, frequency, cell of origin, and general clinical presentation.

Chapter 12. Diseases of the Endocrine System To master 1. The main endocrine organs. 2. The normal structure and function of thyroid gland. 3. The definition, etiology, pathological features and the clinical features of diffuse nontoxic and multi-nodular goiter, excessive secretion of thyroid hormone. 4. The pathological changes and prognosis of the thyroid follicular adenoma and thyroid carcinoma. 5. The definition and classification of diabetes mellitus. To be familiar with 1. The pathological changes of inflammation thyroid diseases. 2. The etiology, pathological changes, clinical features and chronic complications of diabetes mellitus. To understand 1. The etiology, pathological changes and clinical features of cretinism, and myxedema. 2. The etiology, and clinical features of inflammatory thyroid diseases. 147

3. The clinical features of the thyroid follicular adenoma, and thyroid carcinoma.

Chapter 13. Diseases of Nervous System To master 1. The types of infective meningitis and corresponding etiology, infectious routes, morphology of each type. 2. The types, etiology, infectious routes, and pathologic characteristics of cerebral abscess, viral encephalitis (including Japanese B encephalitis) and spongy encephalitis. 3. The terms: soften focus, perivascular cuffing, microglial nodules, neurophagia. To be familiar with 1. The types of degenerative diseases and corresponding etiology, pathogenesis, morphology, and clinical presentation of Alzheimer’s disease/AD, and Parkinson’s disease/PD. 2. The etiology, pathogenesis, prognosis of meningitis, encephalitis, spongiform encephalopathies, AD and PD. To understand The clinical features of meningitis, encephalitis, spongiform encephalopathies, AD and PD.

Chapter 14. Infectious Diseases To master 1. Basic and advance pathologic changes, pathomorphology of primary and secondary pulmonary tuberculosis. 2. The difference between primary and secondary pulmonary tuberculosis in terms of age of hosts, infective pathway, localization of the lesion, gross and microscopic changes, radiography and sequelae. 3. The main pathological changes and natural history of secondary pulmonary tuberculosis related to pathological types. 4. The main pathological changes and the commonest tissues involved in extrapulmonary tuberculosis (intestine, kidney, meninges, bone, lymph node). 5. The terms: Caseous necrosis, Epithelioid cell, Langhan’s giant cell, Granuloma, cold abscess, Ghon’s complex (primary complex), Secondary tuberculosis, Tuberculoma. 6. The pathologic characteristics including tissues commonly invaded and main morphologic changes, main infectious routes and susceptible herd of typhoid fever, bacillary dysentery, and 148

leprosy. 7. The types/stages and corresponding pathological changes of typhoid fever, bacillary dysentery, and leprosy. 8. The terms: typhoid cell, typhoid granuloma, pseudomembrane, clear zone, erythema nodosum leprosum, and Lucio’s phenomenon. 9. The pathologic characteristics including tissues commonly invaded and main morphologic changes, main infectious routes and susceptible herd of gonnorhea, condyloma acuminate, syphilis, and AIDS. 10. The difference between gumma and tubercle. 11. The stages of syphilis and main morphologic changes respectively. 12. The effects of HIV infection on immune system, opportunistic infection and malignant neoplasms. 13. The terms: Condyloma acuminate, Koilocytes, Gumma, AIDS, and Kaposi's sarcoma. To be familiar with 1. The etiology and pathogenesis of tuberculosis including pulmonary and extrapulmonary tuberculosis. 2. The complication, prognosis and diagnosis of typhoid fever, bacillary dysentery and leprosy. 3. The pathogenesis and prevention of AIDS. 4. Diagnosis related to gonnorhea, condyloma acuminate, syphilis, and AIDS. 5. The types of degenerative diseases and corresponding etiology, pathogenesis, morphology, and clinical presentation of Alzheimer’s disease/AD, and Parkinson’s disease/PD. 6. Etiology, pathogenesis, prognosis of meningitis, encephalitis, spongiform encephalopathies, AD and PD. To understand 1. The clinical features of typhoid fever, bacillary dysentery, and leprosy. 2. The clinical manifestation, diagnosis and outcome of pulmonary and extrapulmonary tuberculosis. 3. The clinical manifestation, complication and prognosis of gonnorhea, condyloma acuminate, syphilis and AIDS.

Ⅲ. Practice Requirements Introduction 149

Pathology is a discipline that bridges clinical practice and basic science, and it involves the investigation of the underlying causes (etiology) of disease as well as the mechanisms (pathogenesis) that result in the presenting signs and symptoms of the patient. To understand the structural and functional changes that occur in cells, tissues, and organs, pathologists use contemporary molecular, microbiologic, and immunologic techniques. To render diagnoses and guide therapy in the clinical setting, pathologists identify changes in the gross or microscopic appearances (morphology) of cells and tissues. For a medical student, you must know the common causes of diseases, the pathologic changes and the features of development. However, pathology is not easy. There is a huge amount of material and many new concepts and diseases. If you don't understand something, we want to know about it right away. Consult your textbooks, student instructors, teachers and course directors. The Methods and Contents of Pathological Practice In the histopathological laboratories there are a lot of gross specimens and tissue sections. You must learn how to study them. 1. Gross Specimens: They are extracted from autopsy and surgical operations, and contained in glass or plastic boxes and immersed in 10% formalin solution. So you must be careful when you hold or move a glass specimen. If the glass box breaks, formalin solution and vapor could hurt your eyes, skin and upper respiratory tract. Please wash it using clean water immediately. Key points of observation: What kind of organ? Is it a complete organ or a part of it? Its size, shape, color, hardness, constitution, surface and cut surface. Compare this with the normal one. Find the lesion or lesions. Describe it (or them) and make the pathological diagnosis or pathological lesion combining the clinical data, the pathological diagnosis or lesion consists of two parts: name of organ plus lesion or disease, for example, brain abscess, breast cancer and etc. 2. Tissue Sections and Microscope: Before class, you must know how to correctly use the light microscope. When moving the microscope on the table, you must use both hands. Key points of observation: You should see the slide firstly with naked eyes, find the localization number, and shape of the tissue in the glass. Then see it under the low power objective lens (4×). Recognize what kind of tissue, whether normal or abnormal. Where the lesion localizes and the relationship between lesion and surrounding tissue. Then closely observe the lesion under the high power objective lens and find the morphological characteristics of cells and tissue. 150

Describe them using the medical and pathological terminologies and make the diagnosis combining the clinical data. Note: move the objective lens carefully to avoid breaking the glass. The teaching glass slides are conserved in a box according to number; please return all glass slides, which you used, after your practice. Most slides are in H&E stain.

Chapter 1. Adaptation, Injury and Repair of Cell and Tissue 1. To grasp the morphologic characteristic of hydropic degeneration, fatty degeneration of liver, hyaline degeneration and their clinical effects. 2. To grasp the morphologic characteristic of necrosis and its outcome. 3. To grasp the morphologic characteristic of granulation tissue, and its effect in repair. 4. To be familiar with morphologic changes of different types of atrophy. 5. To understand the morphologic characteristics of pathological pigments.

Chapter 2. Hemodynamic Disorders and Abnormalities of Blood Supply 1. Describe the general characteristics and effects of congestion. 2. Describe the morphologic characteristics and sequelae of thrombosis. 3. Compare the morphologic characteristics of various types of infarction. 4. Understand the relationship among thrombosis, embolus and infarction.

Chapter 3. Inflammation 1. Describe the characteristics and implications of various inflammatory cells. 2. Describe the morphologic characteristics and possible outcomes of the fibrinous and purulent inflammations. 3. Compare acute and chronic inflammation.

Chapter 4. Neoplasia 1. Describe the nomenclature of neoplasms. Explain how tumors are named. List the common exceptions to standard terminology. 2. Compare the general characteristics of benign and malignant tumors. 3. Compare the differences between carcinoma and sarcoma. 4. Describe the main routes of metastasis. 151

Chapter 5. Cardiovascular Disease 1. To grasp the basic pathological changes of rheumatic heart disease (including acute and chronic lesion). 2. To grasp the basic pathological changes of atherosclerosis and its effects on ischemic heart disease. 3. To grasp the basic vascular pathological changes of primary hypertension and its effects on the heart, brain and kidney. 4. To be familiar with the basic pathological changes of endocarditis.

Chapter 6. Diseases of the Respiratory System 1. To grasp the concepts and recognize the morphological changes of pneumonias: lobar pneumonia, bronchopneumonia and viral pneumonia. 2. To be familiar with the morphological changes of chronic obstructive pulmonary diseases: chronic bronchitis, emphysema and bronchiectasis. 3. To be familiar with the morphological changes of carcinoma of the lung

Chapter 7. Diseases of the Digestive System 1. To grasp the pathological features of peptic ulcer. 2. To grasp the pathological features and their consequences in various liver cirrhosis and to compare small nodular cirrhosis of liver with large nodular cirrhosis of liver in every aspect. 3. To grasp the characters and clinico-pathology relationship of various types of hepatitis. 4. To grasp the morphologic features of the common malignant gastrointestinal tumors.

Chapter 8. Urinary System Diseases 1. To grasp the pathologic changes, clinicopathologic correlations of acute diffuse proliferative glomerulonephritis, and chronic sclerosing glomerulonephritis. 2. To be familiar with the characteristic of crescentic glomerulonephritis, acute and chronic pyelonephritis. 3. To understand the characteristics of other kinds of glomerulonephritis. 4. To understand the characteristics of tumor of kidney and urinary bladder.

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Chapter 9. Genital System Diseases 1. To grasp the pathologic changes and spread routes of cervical and breast carcinomas. 2. To be familiar with the morphology and clinicopathologic correlations of gestational diseases. 3. To understand the basic pathologic changes of prostatic hyperplasia and penis carcinoma. 4. To understand the basic pathologic changes of ovarian tumors.

Chapter 10. Diseases of the Endocrine System To understand the pathologic changes of diffused nontoxic and multi-nodular goiter and diffused toxic goiter.

Chapter 11. Tuberculosis 1. To grasp the basic pathological characteristics and infectious routes of tuberculosis. 2. To grasp the pathological characteristics and sequences of primary and secondary tuberculosis. 3. To grasp the differentiation between primary and secondary tuberculosis. 4. To understand the pathological characteristics of extra pulmonary tuberculosis.

Chapter 12. Infectious diseases 1. To understand the types and the pathological characteristics of leprosy. 2. To grasp the pathological characteristics and clinico-pathology relationship of epidemic meningitis and epidemic encephalitis B and the difference between the diseases. 3. To be familiar with the pathological characteristics and complications of typhoid fever and bacillary dysentery.

Ⅳ. Hours Distribution

Content Lecture Lab 80 64 Adaptation and Injury of Cell and Tissue 6 8 Tissue Repair 3 Hemodynamic Disorders and Abnormalities of Blood Supply 5 4

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Inflammation 6 8 Neoplasia and the Malignancies of Hematopoietic and Lymphoid Systems 12 8 Disease of Cardiovascular System 8 8 Diseases of Respiratory System 6 4 Diseases of Digestive System 9 8 Diseases of Immunity 3 Diseases of the Urinary System 5 4 Diseases of the Genital System and Breast 3 4 Diseases of the Endocrine System 3 Diseases of Nervous System 3 Infectious Diseases 8 8

Ⅴ. Assessment

Mid-Semester test 25% Attendance and Performance 10% Practice 20% Final Test 45% Total 100%

Ⅵ.Textbook and References Text Book 1. Robbins Basic Pathology (9th edition), 2012, Elsevier Inc. 2. A Guide of Pathologic Practice (for English class) edited by Department of Pathology, Medical College, Southeast University. 3. Adaptation edited by Zhou Gengyin, and Jiang Xucheng.

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Medical Microbiology

Credits: 5 Total hours: 96 Lectures hours: 64 Experiment hours 32 Grade: 3rd Semester: 1 Jun Dou Da-Qing Gao Ji-Pei Liao Ying Zhang Compilers: Yu Zhao Meng Cao Email: [email protected]

Ⅰ. Preamble and Objectives Convenient to students’ studying the course, the main contents of the curriculum are arbitrarily divided into three kinds: “master”, “be familiar with” and “understand” which expect different approaches from students. 1. The “Master”- contents are the most essential and the most important contents, and students must be able to precisely memorize this category of contents and correctly paraphrase them. 2. The “be familiar with”- contents are the main contents, and students must know this second kind of contents. 3. The “understand”-contents belong to the general/common contents, and students only need to recognize and comprehend them.

Ⅱ.Contents and Requirements Chapter 6. Preface To master the definition of microorganism, the categories of different microorganisms, and the main differences among bacteria, fungi, and viruses. To be familiar with the natural distribution of microorganisms, and the relationship between microorganisms and humans. To understand 155

the research field and the developing history of Medical Microbiology, as well as the new emerging and re-emerging pathogenic microorganism. Course Contents 1. Microorganisms: 1) Definition, 2) Distribution in nature. 3) Classification; i. Eukaryotic microorganisms; fungi, ii. Prokaryotic microorganisms; bacteria, mycoplasmas, chlamydia, rickettsiae, spirochetes, and actinomycetes, iii. Non-cellular microorganisms; viruses. 4) The roles in nature and human health. 2. Microbiology: 5) The research goals and contents, 6) The history in brief; i. The utilization of microorganisms in ancient times. ii. The discovery of microorganisms. iii. The current development of Medical Microbiology. iv. The formation and development of Immunity. 3. Medical Microbiology: 7) The research goal and contents. 8) The development trends in Medical Microbiology; i. New emerging and re-emerging pathogens, drug-resistant pathogens. ii. New diagnostic means. iii. New vaccines. iv. New treatment measures.

Chapter 7. Morphology and Structure of Bacteria To master he size, basic shape and arrangement of bacteria, and the structure, composition and medical significance of bacterial cell wall. Also, master the definition and medical significance of special bacterial structures. 156

To be familiar with the characteristics and medical significance of L-form bacterium. Course Contents 1. Size and units of measurement. 2. Basic shapes and arrangement: cocci, bacilli, and spiral bacteria. 3. Bacterial Basic Structure: 1) Cell wall: i. Functions; a) The primary chemical components: peptidoglycan, teichoic acid, outer membrane, b) L forms (cell wall-defective bacteria), ii. The differences between gram-positive cell wall and gram-negative cell wall and their medical significance. 2) Cytoplasm membrane. 3) Bacterial cytoplasm: ribosomes, plasmids, storage granules. 4) Nucleoid. 4. Bacterial special structures: 5) Capsule or slime layer; i. Chemical compositions; ii. The role of capsule in pathogenicity: antiphagocytosis, resistance to desiccation. 6) Flagellum and function: antigeniccity, motility, virulence of some pathogenic bacteria. 7) Pilus: i. Common pilus (or ordinary pilus): the structure involved in adherence of bacteria to host cells, ii. Sex pilus (or F pilus): the structure involved in genetic transfer and recombination of bacteria. 8) Endospores (or spores); i. The formation of spores, ii. The medical significance of spores in terms of disinfection and sterilization.

Chapter 8. Physiology of Bacteria To master 157

1. the requirements of bacterial growth: 2. the characteristics of the bacterial growth curve. 3. the anabolic metabolic products of bacteria and their medical significance. 4. the definition and significance of bacterial colonies. To be familiar with the reasons that make obligate anaerobes, in which they can’t grow in free oxygen conditions. Also be familiar with catabolic processes and biochemical testing. To understand the classification of bacteria. Understand the definition, classification of culture medium and the phenomena of bacterial growth on media, also known as artificial cultivation of bacteria. Course Contents 1. Growth of bacteria. 2. Growth Requirements: 1) Requirements for bacterial growth; i. Nutrient requirement; e.g., water, carbon source, nitrogen source, inorganic salts, growth factors,

ii. Gas requirement; carbon dioxide (CO2), oxygen (O2), a) Temperature requirement, b) Hydrogen ion concentration (pH), and c) Osmotic Pressure. 2) The mode of bacterial multiplication, 3) The rate of bacterial growth and multiplication, 4) Population growth curve: i. Lag phase, ii. Exponential phase / log (logarithmic) phase, iii. Stationary phase, iv. Death phase. 3. Bacterial Metabolism: 1) Bacterial Catabolism; primary catabolic products and their medical uses. 2) Bacterial Anabolism; primary anabolic products and their medical significance. 3) Bacterial pathogenicity (toxin, invasive enzyme, and pyrogen); 4) Treatment of infectious disease (antibiotic and vitamin); 158

5) Bacterial identification (bacteriocin and pigment). 4. 4. Bacterial Cultivation: 6) The purpose of artificial cultivation of bacteria, 7) Culture media; i. Classification: physical forms; chemical constituents; Laboratory uses. 8) Growth of bacteria in culture media; ii. In liquid media, iii. On solid media: the colony and its significance, iv. In semisolid media. 5. Classification of Bacteria

Chapter 9. Disinfection and Sterilization To master

1. Master the definitions of sterilization, disinfection, asepsis, antiseptic, bacteriostasis and aseptic technique. 2. Master the categories, principles and application of heat sterilization. 3. Master pasteurization, and the principle, application, and characteristics of ultraviolet radiation. To be familiar with 1. Be familiar with the principle, approaches and applicable range of commonly used physical and chemical disinfection. 2. Be familiar with the factors influencing the efficacy of disinfectants. To understand Understand that moist heat sterilization is better than dry heat sterilization. Course Contents 1. Terms: sterilization, disinfection, antisepsis, asepsis, bacteriostasis, and aseptic techniques. 2. Antimicrobial methods: 1) Physical methods; i. Heat; moist heat and dry heat; the contrast between moist heat and dry heat; factors influencing the efficacy of heat: e.g., species, ages, number, temperature, time, etc. ii. Radiation; ultraviolet light, ionizing radiation, ultrasonic waves. 159

iii. Filtration. 2) Chemical sterilization and disinfection, 3) Factors influencing the efficacy of chemical disinfectants .

Chapter 10. Bacterial Genetics and Variation To master 1. Master the characteristics of bacterial genetic materials. 2. Master the characteristic of bacteriophages. 3. Master the characteristics of bacterial recombination, transformation, transduction, conjugation and lysogenic conversion. 4. Understand the types of genetic variation of bacteria and the possible reasons. Course Contents 1. Definitions of bacterial heredity and variation: 1) Bacterial genetic materials; i. Bacterial chromosome / nucleoid, ii. Plasmids; a) Characteristics of plasmids, b) Types of plasmids; R plasmids (resistance plasmids), F plasmids (fertility plasmids), Vi plasmids (virulence plasmids), and Col (colicin) plasmids. iii. Transposable element; a) Insertion Sequence, b) Transposons. 2. Bacteriophages (or phages): 1) General characteristics, 2) Life cycles; Virulence phages, and temperate phages. 3. Mechanism of Genetic Variation: 1) Mutation; base pair substitution, frameshift mutations, mutations involving many base pairs, 2) Genetic transfer and recombination; Transformation, Conjugation (F+bacteria, F-bacteria, Hfr bacteria, F’ plasmids; R plasmids), Transduction (generalized transduction, specialized transduction), Lysogenic conversion Chapter 11. Bacterial Infection and Immunity 160

To master 1. Master the concepts of pathogen, nonpathogen, opportunistic pathogen. 2. Master the definition of bacterial pathogenicity, and virulence. 3. Master the definitions of bacteremia, septicemia, toxemia, endotoxemia and pyemia. 4. Master the factors regarding bacterial pathogenicity. To be familiar with Be familiar with the sources of bacterial infection; modes of transmission, and types of bacterial infection. Course Contents 1. Definition: Pathogen, and nonpathogen. 2. Normal Microbial Flora and Opportunistic Bacteria: 1) Definition; Normal microbial flora, 2) Beneficial effects of the normal microbial flora, 3) Opportunistic pathogens; i. Definition, ii. Opportunistic pathogens cause diseases under certain conditions. 3) Alteration of colonization sites of bacteria, 4) Declination of the host immune system function, 5) Dysbacteriosis. 3. Bacterial Pathogenicity: 1) Bacterial virulence factors; adherence factors, invasion of host cells and tissues, Toxins, Enzymes, Antiphagocytic factors, and bacterial biofilms. 4. Host Defence Against Bacterial Infection: 1) Nonspecific Immunity; i. Anatomical barriers, Normal flora, and Phagocytes. ii. Humoral defense mechanisms; Lysozyme and Complement, etc. 2) Specific Immunity; i. Immunity to extracellular bacteria, ii. Immunity to intracellular bacteria. 5. The initiation and course of infection: 1) Sources of infection; exogenous and endogenous infection, 2) Pathway of bacterial entrance; Respiratory transmissions, Gastrointestinal (GI) 161

transmission, Impaired skin, contact, insect vectors, etc. 6. Type of bacterial infection, 1) Inapparent / subclinical infection, 2) Apparent infection; Types of apparent infection and definitions of bacteremia, septicemia, toxemia, endotoxemia, and pyemia.

Chapter 12. Principles of Diagnosis and Prevention of Bacterial Infections To be familiar with Be familiar with the principle and procedures of diagnosis for bacterial infection, To understand 1. Understand the mechanism of serological diagnosis. 2. Understand active immunization and passive immunization against bacterial infection. Course Contents 1. Bacterial diagnosis, 1) Specimen 2) Microscopy and Stains, Isolation and Identification of Bacteria, Cultivation and isolation, Antigen detection, and Molecular diagnostics. 2. Serological Diagnosis, 3. Artificial active Immunity, vaccine and toxoid, adjuvants, 4. Artificial passive immunization,

Chapter 14. Coccus To master 1. Master the distribution, morphology, cultural properties and pathogenicity of Staphylococci. 2. Master the identification of pathogenic Staphylococci. 3. Master the distribution, morphology, cultural properties, and pathogenicity of Streptococcus. To be familiar with 1. Be familiar with the pathogenicity of Streptococcus pneumoniae. 2. Be familiar with the morphology, pathogenicity and control measures of Neisseria meningitides. 3. Be familiar with the morphology, culture properties, resistance and clinical findings of Neisseria gonorrhoeae. 162

Course Contents 1. Staphylococci: 1) Biological characteristics; 2) Pathogenicity; S. Aureus; i. Virulent factors; Surface structures (SPA and capsules), Invasive enzymes (coagulase, hyaluronidase, thermostable nuclease, staphylokinase), and Toxins (hemolysins, leukocidins, enterotoxins, exfoliative toxins, toxic shock syndrome toxin-1). ii. Clinical manifestations; pyogenic diseases, and toxin-associated diseases. 3) Laboratory diagnosis; Microscopy, Cultivation, Biochemical tests, Antibiotic susceptibility tests. 4) Treatment and prevention, 5) Coagulase-negative staphylococci; S. Epidermidis and S. Saprophyticus, 2. Streptococci: 6) General characteristics; 7) Classifications; i. Based on Hemolytic activity, Antigenic structures, 8) Pathogenicity; Group A Streptococci, i. Virulence factors; cell wall components (LTA, M protein); Invasive enzymes (Hyaluronidase, Streptokinase, Streptodornase) and Toxins (Streptolysin, and Erythrogenic toxin). ii. Clinical findings; Pyogenic diseases, Toxin-associated diseases, Hypersensitive diseases, 9) ASOT (anti-SLO Test), 10) Treatment, 3. S. Pneumoniae: 11) General characteristics, 12) Pathogenicity; Virulence factors and clinical findings, 13) Laboratory diagnosis; Direct Gram stain and Identification from other- hemolytic streptococci, 14) Treatment and prevention. 4. Neisseria Gonorrhoeae: 15) Pathogenicity; 163

i. Virulence factors; Pili (main), IgA1 protease, Outer membrane protein (OMP), endotoxin, ii. Clinical findings; Gonorrhea. 16) Treatment and prevention. 5. Neisseria Meningitidis: 17) Pathogenicity; i. Virulence factors; Pili, Polysaccharide capsule and Endotoxin (main). ii. Clinical findings and pathogenesis. 18) Treatment and prevention.

Chapter 15. Enteric Bacilli To master 1. Master the common characteristics of the Enterobacteriaceae family. 2. Master the pathogenicity of Salmonella. 3. Master the definition and interpretation of Widal test. 4. Master the pathogenicity of Shigella. To be familiar with 1. Be familiar with the pathogenesis of pathogenic Escherichia. 2. Be familiar with the danger of carriers in spreading enteric fever. Course Contents 1. General Characteristics of the Enteric Bacilli, 2. Escherichia Coli (E. Coli): 1) Pathogenicity; i. Extraintestinal disease, ii. Intestinal disease: Virulence factors and diseases, iii. Enterotoxigenic E. Coli (ETEC), Enteroinvasive E. Coli (EIEC), and Enteropathogenic, iv. E. Coli (EPEC), Enterohemorrhagic E. Coli (EHEC), Enteroaggregative E. Coli (EAEC). 2) Treatment and Prevention. 3. Shigella and Shigellosis: 1) Pathogenicity; 164

i. Virulence factors; Pili, Endotoxins, and Exotoxins, ii. Clinical disease; bacillary dysentery. 2) Immunity and Treatment. 4. Salmonella and Salmonellosis 1) Pathogenicity; i. Virulence factors; Invasiveness, Endotoxins, and Exotoxins. ii. Clinical disease; Enteric fever, Enterocolitis (or food poisoning), and Septicemia. 2) Immunity and Treatment.

Chapter 16. Vibrio To master 1. Master the shape, culture and types of Vibrio cholera. 2. Master the pathogenicity, immunity, prevention and treatment of Vibrio cholera. To be familiar with Be familiar with the main biological characteristics, pathogenicity of V. Parahaemolyticus. Course Contents 1. General Characters and Classification of Vibrio. 2. V. Cholerae: 1) Biological characteristics; shape and structure, culture, antigenicity and classification. 2) Virulence factor; flagella, pili, and enterotoxin. 3) Mechanism of enterotoxin. 4) Clinical disease; cholera. 5) Treatment and prevention. 3. V. Parahaemolyticus: 1) Morphology. 2) Pathogenicity; i. Virulence factors; hemolysins. ii. Clinical disease; gastroenteritis (food poisoning), iii. Treatment and prevention.

Chapter 17. Campylobacter Jejuni and Helicobacter Pylori To master 165

1. Master the shape, and culture of Helicobacter pylori. 2. Master the pathogenicity, and prevention of Helicobacter pylori. To understand Understand the main biological characteristics, and pathogenicity of Campylobacter jejuni. Course Contents 1. Campylobacter Jejuni: 1) Biological characteristics; shape, structure, culture, and antigenicity. 2) Pathogenicity and Disease. 3) Laboratory diagnosis. 2. Helicobacter Pylori: 1) Biological characteristics; shape, structure, culture, and antigenicity. 2) Pathogenicity and Clinical disease. 3) Laboratory diagnosis.

Chapter 18. Anaerobic Bacteria To master 1. Master the characteristics of infection and culture of anaerobes. 2. Master the pathogenesis, immunity, treatment and prevention of the major clostridia. To be familiar with Be familiar with the distribution, classification and pathogenicity of non-spore forming anaerobes. Course Contents 1. C. Tetani: 1) Virulence factors; tetanospasmin. 2) Clinical disease; Tetanus (Tetanus neonatorum / Neonatal tetanus). 3) Immunity. 4) Treatment and prevention; Proper care of contaminated wounds, Tetanus antitoxin, active immunization with the tetanus toxoid vaccination for children, for a high-risk group and for patients in question. 2. C. Perfringens: 1) Virulence factors; alpha toxin, and enterotoxin. 2) Clinical disease; gas gangrene, food poisoning, and necrotizing enteritis. 3. C. Botulinum: 166

1) Virulence factors; botulinum toxin. 2) Clinical disease; food poisoning, and infant botulism. 4. C. Difficile: 1) Virulence factors. 2) Clinical disease; pseudomembranous colitis. 3) Treatment. 5. Non-Spore forming Anaerobes: 1) Conditions causing diseases. 2) Characteristic properties of infections. 3) Disease; dental infection, brain abscess, respiratory infection, abdominal infection, wound infection following surgery or trauma, female genital tract infection, and septicemia.

Chapter 19. Corynebacterium To be familiar with 1. Be familiar with the morphology, pathogenicity, and prevention of Corynebacterium diphtheriae. 2. Be familiar with the immunity and microbiological examination of Corynebacterium diphtheria. Course Contents 1. Corynebacterium: 1) Corynebacterium diphtheria; i. Characteristics of the shape, staining and metachromatic granule. ii. Pathogenicity; diphtheria toxin, and pathogenesis. iii. Immunity; permanent. iv. Microbiological examination; Schick's test. v. Prevention; toxoid, and antitoxin. 2) Briefly introduce Corynebacterium diphtheroides.

Chapter 20. Mycobacteria To master 1. Master the important Mycobacterium. 167

2. Master the shape, stain, culture and resistance, pathogenicity and immunity of Mycobacterium tuberculosis. 3. Master the principle and interpretation of tuberculin test. 4. Master the inoculation of BCG for prevention. To understand Understand the pathogenicity of Mycobacterium Leprae. Course Contents 1. Classification of mycobacterium: M. tuberculosis, Atypical mycobacteria, and M. leprae. 2. General characteristics of Mycobacteria. 3. M. Tuberculosis: 1) Biological characteristics; i. Shape and structure; mycolic acid, wax D, cord factor, and protein. ii. Cultural characteristics. iii. Resistance. 2) Virulence factors; lipids, proteins, and polysaccharides. 3) Pathogenicity; i. Causative agents. ii. Transmission; Respiratory route (main), gastrointestinal route, and impaired skin. iii. Clinical disease; Primary tuberculosis, and secondary tuberculosis. 4) Immunity; i. Immunological reaction; Koch phenomenon. ii. Tuberculin test; old tuberculin (OT) and purified protein D (PPD), mechanism and method, and clinical implication. 5) Laboratory diagnosis; i. Specimen collection, ii. Microscopic examination, iii. Cultivation with enrichment media and chemical tests, iv. Tuberculin test. 6) Treatment. 7) Prevention; BCG vaccine (Bacillus Calmette-Guerin). 4. M. Leprae: 168

8) General properties. 9) Pathogenicity; i. Transmission; respiratory route, and contact. ii. Disease; leprosy (lepromatous leprosy, and tuberculoid leprosy). 10) Treatment and prevention.

Chapter 21. Parvobacillus To be familiar with 1. Be familiar with the morphology, pathogenicity, and prevention of Hemophilic influenza. 2. Be familiar with the morphology, pathogenicity, and prevention of Bordetella pertussis. 3. Be familiar with the morphology, pathogenicity, and prevention of Legionella pneumophila. Course Contents 1. Hemophilic Influenzae: 1) General characteristics, 2) Pathogenicity; i. Transmission and pathogenesis, ii. Clinical disease; pneumonia, sinusitis, otitis, meningitis, and epiglottitis. 3) Treatment and prevention. 2. Bordetella Pertussis: 4) General characteristics, 5) Pathogenicity; i. Transmission and pathogenesis, ii. Clinical disease; catarrhal state → paroxysmal stage → convalescence stage. 6) Treatment and prevention. 3. Legionella Pneumophila: 7) General characteristics, 8) Pathogenicity; i. Transmission and pathogenesis, ii. Clinical disease; pneumonia. 9) Treatment and prevention.

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Chapter 22. Zoonotic Bacteria To master Master the definition of zoonosis and the zoonotic bacteria that are pathogenic to human beings. To be familiar with Be familiar with the pathogenesis, prevention, treatment of the major zoonotic bacteria. Course Contents 1. Bacillus Anthracis: 1) Morphological Characteristics. 2) Virulence factors; capsule anthrax toxin. 3) Disease; cutaneous anthrax, pulmonary (inhalational anthrax), and gastrointestinal anthrax. 4) Treatment and prevention. 2. Brucella: 5) General characteristics, 6) Pathogenicity; i. Virulence factors; invasive factors, and endotoxin. ii. Transmission and pathogenesis. iii. Clinical disease; brucellosis. 7) Treatment and prevention. 3. Yersinia: 8) Classification; Y. Pestis, Y. Enterocolitica, and Y. Pseudotuberculosis, and Y. pestis. i. Sources of infection and Transmission. ii. Virulence factors; MT (murine toxin), V-W antigens capsules, and LPS endotoxin. iii. Disease; plague. 9) Immunity. 10) Treatment and prevention.

Chapter 23. Other Bacteria To understand Understand the main biological characteristics, pathogenicity, microbiological examination and prevention of Pseudomonas aeruginosa and Listeria monocytogenes. 170

Course Contents 1. Pseudomonas Aeruginosa: 1) Environmental distribution, 2) Disease; pulmonary infections, primary skin and soft tissue infections, urinary tract infection, and ear infection. 3) Treatment and prevention. 2. Listeria Monocytogenes: 4) Disease; listeriosis (nausea, abdominal pain, et al). 5) Treatment and prevention.

Chapter 24. Actinomyces and Nocardia To be familiar with 1. Be familiar with the difference between actinomycetes and eukaryotes. 2. Be familiar with the main pathogenic actinomycetes. To understand Understand the definition of actinomycete, it’s main biological characteristics, pathogenicity, microbiological examination, and prevention. Course Contents 1. Actinomycetes: 1) Distribution, 2) Biological Characteristics, 3) Pathogenicity; pathogenic factor, 4) Immunity, 5) Laboratory diagnosis; Sulfur granule, 6) Prevention and treatment.

Chapter 25. Spirochetes To master Master the various symptoms associated with the stages of syphilis. To be familiar with Be familiar with the major biological properties of Treponema Pallidum and Leptospira. To understand 171

Understand the important laboratory tests used to identify the syphilis organism. Course Contents 1. Classification: Treponema, Borreli, and Leptospira. 2. Treponema Pallidum: 1) Biological property; Morphology, Staining, Culture, and Resistance. 2) Pathogenicity; Pathogenic factor, Disease: Syphilis, Source of infection, and Route of transmission. 3) Immunity. 4) Microbiological diagnosis; i. Microscopy ii. Serologic test; Nontreponemal tests, and Treponemal tests. 5) Prevention and treatment. 3. Leptospira: 6) Biological property; Morphology, Staining, Culture, and Resistance. 7) Pathogenicity. i. Pathogenic factor; Cytotoxic factors (CTF), Hemolysin, and Endotoxin-like material. ii. Disease; leptospirosis; Source of infection; Route of transmission; and Clinical course. 8) Immunity. 9) Microbiological diagnosis. i. Microscopy, Isolation, Animal inoculation, Serologic tests; microscopic agglutination test (MAT). 10) Treatment and prevention

Chapter 26. Chlamydie To master 1. Master the biological characteristics of Chlamydiae; development cycle. 2. Master the diseases caused by Chlamydiae Trachoma, Chlamydiae Pneumonia, and Chlamydiae psittaci. Course Contents 1. Biological property: 172

1) Developmental cycle; Elementary body (EB), Reticulate body / initial body (RB). 2) Culture, 3) Resistance, 4) Classification. 2. Pathogenicity: 5) Pathogenic substance; Endotoxin, Multiplication, some protein. 6) Disease. 3. Trachoma: 7) Sexually transmitted disease (STD); Biovar trachoma serotypes D~K, L2a and Biovar lymphogranuloma venereum. 8) Respiratory infections; C. Pneumonia, and C. Psittaci.

Chapter 27 . Mycoplasmas To master 1. Master the concept of mycoplasma and it’s major biological properties. 2. Master the differences between mycoplasma and L-forms. 3. Master the routes of transmission of Mycoplasma pneumonia, and the diseases caused by it. To be familiar with Be familiar with the diseases caused by Mycoplasma. To understand Understand the significance of the mycoplasmas as agents of sexually transmitted disease. Course Contents 1. Biological properties: 1) Morphology, 2) Structure, 3) Growth Characteristics, 4) Resistance, 5) Mycoplasmas and L-form bacteria. 2. Mycoplasma pneumonia: 6) Pathogenesis, 7) Diseases; 8) Primary atypical pneumonia (walking pneumonia). 173

9) Tracheobronchitis, 10) Immunity, 11) Microbiological diagnosis; Culture, and Serological tests. 12) Treatment. 3. Other species; Ureaplasma Urealyticum, M. Genitalium, and M. Hominis.

Chapter 28. Rickettsia To master 1. Master the major biological properties of Rickettsiae and the routes of transmission. 2. Master the Weil-Felix reaction concepts To be familiar with Understand the pathogenesis and the diseases caused by pathogenic Rickettsiae. Course Contents 1. Biological properties: 1) Morphology and Structure, 2) Culture, 3) Resistance. 2. Pathogenicity: 4) Pathogenic substance; LPS, and Phospholipase A. 5) Disease; Route of infection, Pathogenesis, and Clinical symptoms. 3. Immunity, 4. Microbiological diagnosis: 6) Serologic tests; Specific test, Nonspecific test, and Weil-Felix reaction. 7) Isolation and culture. 5. Main pathogenic Rickettsiae: 8) Rickettsia Prowazekii; i. Source of infection, Vector, Transmission ii. Disease; Epidemic typhus. iii. Immunity 9) Rickettsia Typhus / Rickettsia Mooseri; i. Reservoir, vector, and transmission. ii. Clinical Disease; Endemic typhus or murine typhus. 174

iii. Immunity. Chapter 29. General Properties of Viruses To master 1. Master the structure of viruses. 2. Master the chemical composition and function of viruses. 3. Master the following concepts: virion, nucleocapsid, naked virus, enveloped virus, defective virus, and prion. 4. Master the structural difference between viruses and bacteria. To be familiar with Be familiar with the classification of viruses. To understand Understand the size and shape of viruses. Course Contents 1. Morphology of Virus: 1) Size and Shape, 2) Structure; Naked virus, and enveloped virus. 3) Types of symmetry of viral particles. i. Helical symmetry, ii. Icosahedral symmetry, iii. Complex symmetry. 2. Chemical Composition: 4) Viral nucleic acid, 5) Viral protein; Capsid protein, Envelope protein, viral lipids, and viral carbohydrates. 3. Classification and nomenclature of viruses.

Chapter 30. Multiplication and Variation of Viruses To master 1. Master the major feature of the replication cycle of viruses. 2. Master the abnormal replication of virus. 3. Master the definition of viral interference. To be familiar with Be familiar with the effects of physical and chemical agents on virus. 175

To understand Understand the categories and mechanisms of viral genetics and variation. Course Contents 1. Viral Replication: 1) General steps; Attachment (adsorption), Penetration, Uncoating, Biosynthesis, Assembly, and Release. 2) Abnormal replications; i. Defective viruses, DIP, helper virus, ii. Abortive infection; non-permissive cells, and permissive cells. 2. Viral Interference: 3) Definition, 4) Range of interference occurrence, 5) Mechanisms, 6) Significance; advantage and disadvantages. 3. Viral Genetics and Variation: 7) Gene Mutation, i. Temperature Sensitive Mutant (ts), ii. Host-Range Mutant (hr), iii. Drug-Resistant Mutant. 8) Recombination and Reassortment, 9) Integration, 10) Complementation, 11) The significance and application of virus genetics and variation. 4. Reaction to Physical and Chemical Agents: 12) Heat and cold, 13) PH, 14) Radiation, 15) Chemicals.

Chapter 31. Viral Infection and Immunity To master 1. Master the modes and types of viral infection. 176

2. Master the pathogenesis and immunopathogenesis of viral infection. 3. Master the antiviral activity of IFN. 4. Master the antiviral activity of viral neutralizing antibody. 5. Master the following concepts: vertical transmission, CPE, latent infection, slow virus infection. To understand Understand the characteristics of immunity against viral infection. Course Contents 1. Modes of viral infection: Horizontal transmission, Vertical transmission. 2. Routes of viral infection: 1) Horizontal transmission; i. Respiratory route, ii. Alimentary route (gastrointestinal route), iii. Skin and mucosa, iv. Other routes. 2) Vertical transmission; Placenta, Birth canal, Breastfeeding, etc. 3. Types of viral infection: 3) Unapparent infection, 4) Apparent infection; i. Acute infection ii. Persistent infection; Chronic infection, Latent infection, and Slow viral infection. 5) Mechanism for persistent infection. 4. Viral Pathogenesis: 6) Direct Virus-Host Cell Interaction; Cytopathogenesis. i. Cytolytic infection or cytocidal infection, ii. Steady state infection, iii. Integration infection, iv. Characteristic changes in host cells, v. Apoptosis, 7) Virus-Induced Immunopathology; i. Humoral immunopathology, 177

ii. Cell-mediated immunopathology, iii. Virus-induced immunosuppression, 5. Antiviral Immunity: 8) Non-specific immunity; i. NK cells, ii. Interferon (IFN); Conception, Classification, Bioactivity, Induction of IFNs, and mechanism of action. 9) Specific immunity; i. Humoral immunity; neutralizing antibodies (IgG, IgM, and IgA), Hemagglutination inhibiting antibodies (IgM and IgG), Complement fixation antibodies, ii. Cellular immunity 10) Duration of antiviral immunity.

Chapter 32. Diagnosis of Viral Infection To be familiar with Be familiar with viral culture (cell, tissue and body level). Course Contents 1. Diagnosis of Viral Infection: 1) Specimens collection, 2) Viral isolation and growth; i. Animal inoculation, Embryonated eggs (chick embryo), and Tissue culture. ii. Indications of viral growth in cell cultures; CPE, Inclusion body formation, Hemadsorption, Interference, Transformation, and Immunofluorescence; iii. Detection assay of viral infectivity; Plaque, TCID50 (50% tissue culture infectious dose), ID50 (50% infectious dose), MOI (multiplicity of infection). 3) Serologic tests; hemagglutination inhibition test. 4) Viral nucleic acid detection; Southern and Northern blotting, PCR, RT-PCR, In situ hybridization, Dot blotting, and Biochip.

Chapter 33. Prevention and Treatment of Viral Infection To be familiar with 178

1. Be familiar with the immunization prevention of viral infection (artificial active and passive immunization). 2. Be familiar with the examination methods of viral infection. 3. Be familiar with the characteristics of antiviral agents. Course Contents 1. Control of Viral Infection: 1) Active immunization; vaccines; inactivated vaccines, attenuated live vaccines, subunit vaccines, polypeptide vaccines, and Temperature-sensitive strain vaccines. 2) Passive immunization.

Chapter 34. Hepatitis Viruses To master 1. Master the characteristic properties of HBV. 2. Master the diagonosis of HBV in a clinical laboratory. 3. Master the transmission ways of HBV. To be familiar with Be familiar with the classification of hepatitis viruses. To understand Understand the gene types, transmission ways, pathogenesis and diagnosis of other hepatitis viruses. Course Contents 1. Hepatitis A Virus: 1) Biological properties; morphology, cultivation, and resistance. 2) Pathogenesis; source of infection, route of transmission, and clinical findings. 3) Immunity. 4) Microbiologic diagnosis; HAV- IgM, HAV- IgG, HAV RNA detection. 2. Hepatitis B Virus: 5) Biological properties; i. Morphology; Big spherical particle, small spherical particle, and tubular particle. ii. Antigenic compositions; HBsAg, HBcAg, HBeAg, and PreS antigen. iii. Cultivation and Resistance. 6) Pathogenesis and immunity; source of infection, route of transmission, and disease. 179

7) HBV and Primary Hepatocellular Carcinoma (Hepatoma), 8) Microbiological diagnosis; i. Antigen-Antibody System of HBV. ii. Detect HBV DNA and HBV DNA polymerase. 9) Prevention and control. 3. Hepatitis C Virus: 10) Biological properties, 11) Pathogenesis; source of infection, route of transmission, and diseases, 12) Immunity, 13) Prevention and control. 4. Hepatitis D Virus: 14) Biological properties, 15) Pathogenesis; route of transmission, and clinical characteristics. 5. Hepatitis E Virus: 16) Biological properties, 17) Pathogenesis; route of transmission, and clinical characteristic.

Chapter 35. Respiratory Viruses To master 1. Master the major members of respiratory viruses. 2. Master the morphology, antigen types, variations and prevention of influenza virus. 3. Master pathogenicity of Influenza virus, Measles virus, Mump virus, and Rubella virus. 4. Master the morphology, pathogenicity, and prevention of SARS virus. To be familiar with Be familiar with main biological characteristics of Paramyxoviridae. To understand 1. Understand the control of influenza virus, measles and mumps. 2. Understand the source of infection, routes of transmission, and main clinical symptoms of Parainfluenza virus. Course Contents 1. Classification: Orthomyxoviruses; Paramyxoviruses; Others. 2. Influenza virus: 180

1) Biological properties; i. Morphology, ii. Typing and variations, iii. Cultivation, iv. Resistance. 2) Pathogenicity; i. Source of infection, ii. Route of transmission, iii. Pathogenesis, iv. Clinical features. 3) Immunity; 4) Microbiological diagnosis; i. Isolation and identification, ii. Rapid diagnosis by Immunofluorescence or EIA tests, iii. Serological tests 5) Prevention and Treatment; i. Influenza vaccine (whole virus vaccine) HA-NA subunit vaccine, ii. Anti-viral drugs. 3. Paramyxoviruses: 1) Common properties; i. Size and Structure; ii. Two glycoproteins on the envelope. 2) Measles virus; i. Biological properties, ii. Pathogenicity; Source of infection, Transmission, Pathogenesis, Clinical manifestation, SSPE (subacute sclerosing panencephalitis). iii. Immunity, Treatment and Prevention. 3) Mumps virus; i. Biological properties, ii. Pathogenicity; Source of infection, Transmission, Pathogenesis, and Clinical manifestation, iii. Immunity, 181

iv. Prevention. 4) Parainfluenza virus; types, and pathogenesis. 5) Respiratory syncytial virus; Pathogenesis. 4. Other Respiratory Virus; 1) Rubella virus; Pathogenesis, Diseases including relationship with abortion, and Prevention. 2) Adenovirus; Biological properties, Pathogenesis, and Immunity. 3) Rhinovirus; Pathogenesis, 4) Coronavirus; i. SARS virus; morphology, pathogenicity, and prevention. ii. Common coronavirus; diseases.

Chapter 36. Enteroviruses To master 1. Master the members of enteroviruses and the diseases caused by them. 2. Master the common properties of enteroviruses. 3. Master the pathogenesis of poliovirus. To be familiar with Be familiar with the vaccines available for the prevention of poliovirus infection. Course Contents 1. Classification. 2. Common properties: 1) Size, Shape and Structure, 2) Replication, 3) Resistance. 3. Poliovirus: 1) Pathogenicity; i. Source of infection, ii. Route of transmission, iii. Pathogenesis, iv. Clinical features. 2) Immunity; sIgA, IgM, and IgG. 182

3) Prevention and Control; i. Passive immunization, ii. Active immunization; Live attenuated virus, and inactive virus. 4. Coxsackieviruses: 1) Classification; Group A and B. 2) Diversified clinical diseases. 5. ECHO Viruses: Classification, and Pathogenicity. 6. Enterovirus 68~71: Pathogenicity.

GASTROENTERITIS-RELATED VIRUSES To master Master the biological properties and pathogenesis of rotaviruses. To be familiar with Be familiar with the viruses causing human gastroenteritis. Course Contents 1. Human Rotaviruses: 1) Morphology and Classification, 2) Pathogenicity; Route of transmission, High-risk people, Pathogenesis, Diseases. 3) Immunity 2. Calici Viruses; 3. Small Round Viruses.

Chapter 37. Herpesviruses To master 1. Master the members and the common properties of herpesviruses. 2. Master the infection types of HSV. 3. Master the pathogenicity of HSV, VZV, CMV, and EBV. Course Contents 1. Common Property: 1) Morphology of virions, 2) Cultivation, 3) Types of infection. 183

2. Herpes Simplex Virus (HSV): 1) Classification; HSV-1, HSV-2. 2) Pathogenesis, i. Source of infection and route of transmission. ii. Types of infection; primary infections, latent and recurrent infections, and congenital infections. iii. Clinical findings. 3) Immunity; humoral immunity; cellular immunity, 4) Prevention and Treatment. 3. Varicella-Zoster Virus (VZV): 1) Biological Properties, 2) Pathogenic Characteristics; primary infection, and latent infection. 3) Disease; Varicella (or chickenpox), and Zoster (or shingles). 4. Cytomegalovirus (CMV): 1) Culture, 2) Pathogenesis; i. Source of infection, ii. Multiple routes of transmission; close contact, blood transfusion, organ transplantation, and vertical transmission. iii. Clinical types; transplacental infection in fetus; perinatal infection; infections in adolescents and adults. 5. Epstein-Barr Virus (EBV): 1) Biological properties; Host cells. 2) Types of infection; multiplicative infection, latent infection, and malignant transformation. 3) Pathogenesis; i. Route of transmission, ii. Clinical types; infectious mononucleosis, Burkitt's lymphoma, and nasopharyngeal carcinoma. iii. Treatment and prevention. 6. Other Herpesviruses; HHV-6, HHV-7, and HHV-8.

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Chapter 38. Retroviruses and Cancer Associated Viruses To master 1. Master the transmission way of HIV. 2. Master the structure and pathogenesis of HIV. To be familiar with Be familiar with the genome structure, replication, diagnosis, and control of HIV. To understand Understand pathogenesis of HTLV. Course Contents 1. Human Immunodeficiency Virus (HIV): 1) Biological Properties; i. Morphology, ii. Replication, and iii. Resistance. 2) Pathogenesis; i. Source of infection, ii. Routes of transmission; sexual contact, intravenous drug users, transfusion of blood or blood products, vertical transmission through placenta, birth canal, milk, etc. iii. Characteristics of Pathogenicity and Mechanism of CD4+cell injury by HIV. iv. Disease course and clinical features. 3) Immunity 4) Microbiologic diagnosis; Isolation and cultivation, serological test, and rapid diagnosis. 5) Prevention and treatment. 2. Human T Cell Lymphotropic Virus (HTLV): 6) Pathogenesis; i. Routes of transmission; Blood transfusion, Sexual contact, Shared blood- contaminated needles or syringes, Vertical transmission, etc. ii. Diseases.

Chapter 39. Encephalitis Viruses 185

To master 1. Master the common properties of Arboviruses. 2. Master the pathogenesis of Japanese Encephalitis Virus and the clinical illness. 3. Master the pathogenesis, the clinical illnesses and immunity of Dengue Virus. To be familiar with Be familiar with the principle of prevention and control of Dengue virus. To understand 1. Understand the sources of infection and transmission routes of Forest Encephalitis Virus, and clinical illnesses. 2. Know the main diseases caused by West Nile Virus. Course Contents 1. Japanese Encephalitis Virus (Encephalitis B virus): 1) Pathogenicity i. Source of infection ii. Vector; mosquito iii. Pathogenesis iv. Disease 2) Immunity 3) Prevention and control 2. Dengue Virus: 4) Pathogenicity i. Natural host ii. Vector; mosquito iii. Pathogenesis iv. Clinical types of Dengue; Dengue (or Dengue fever), and Dengue shock syndrome (or Dengue hemorrhagic fever). 5) Prevention and control 3. Forest Encephalitis Virus: 6) Sources of infection 7) Routes of transmission 8) Clinical symptoms 4. Briefly introduce the West Nile Virus. 186

Chapter 40. Hemorrhagic Fever Viruses To master Master the main biological properties and pathogenesis of Hantavirus, and Crimean-Congo Hemorrhage Fever Virus (CCHFV). To understand Understand the main epidemiologic features and diseases of other hemorrhagic fever viruses. Course Contents 1. Hantavirus: 1) Biologic property and categories; i. Morphology-Hantaan virus ii. Resistance 2) Pathogenicity; i. Source of infection, ii. Route of infection, iii. Pathogenesis, iv. Major clinical symptoms; hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS). 3) Immunity; 4) Prevention and control 2. Crimean-Congo Hemorrhagic Fever Virus (CCHFV): 5) Biologic properties; 6) Pathogenicity; i. Source of infection, ii. Vector, iii. Disease. 7) Immunity; permanent. 8) Prevention. 3. Briefly introduce epidemiologic features and diseases of Ebola virus, Marburg virus.

Chapter 41. Other Important Viruses To master 187

1. Master the prevention of Rabies. 2. Master definition of PrPc and PrPsc. 3. Master the shape and structure of the Prion. 4. Master the Prion characteristics of pathogenicity and related diseases. To be familiar with 5. Be familiar with the major biological properties, routes of transmission, and pathogenicity of Rabies. To understand 1. Understand the transmission routes of Papillomavirus and Parvovirus, and the main diseases caused by them. 2. Understand the diagnosis and prevention. Course Contents 1. Rabies Virus: 1) Biological property; i. Shape and structure. ii. Host range. iii. Antigenicity 2) Pathogenicity; i. Source of infection, ii. Route of transmission, iii. Incubation period, iv. Symptoms: early phase, phase of excitement, and paralytic phase. 3) Prevention and Control; i. For source of infection. ii. For individuals bitten by a dog; care of wound, passive immunization, and active immunization. 2. Briefly introduce Papillomavirus and Parvovirus. 3. Prion: 4) Prion definition. 5) The shape and structure of prion protein (PrP). i. PrPc: Cellular PrP (normal). ii. PrPsc: Scrapie prion protein (pathogenic). 188

6) Prion pathogenicity. i. The common characteristics of prion diseases. ii. Diseases. iii. Animal prion disease; scrapie of sheep and goat, bovine spongiform encephalopathy (BSE). iv. Human prion disease; Kuru disease, Creutzfeldt-Jakob disease (CJD), Gerstmann-Straussler-Scheinker Syndrome (GSS), Fatal Familial Insomnia (FFI). 4. Microbiological examination and the principle of prevention.

Chapter 42. General Properties of Fungi To master Master the major biological properties of fungi: morphology, structure, and culture. To understand Understand the relationship between the fungal dimorphism and pathogenicity. Course Contents 1. Biological property: 1) Morphology; Yeasts, Molds (filamentous fungi). 2) Culture; i. Culture medium. ii. Optimal growth conditions. iii. Fungal colony; Yeast colony, Yeast-like colony, and Filamentous colony. 3) Resistance. 2. Pathogenicity: 4) Fungal pathogenic factors. 5) Fungal pathogenic patterns: i. Hypersensitivity to fungi, ii. Mycotoxicosis, iii. Fungal toxins and tumors, iv. Fungal infection. 6) Fungal pathogenesis 3. Immunity. 4. Microbiological diagnosis; Specimens, Microscopy, and Culture. 189

5. Treatment and prevention: 7) For dermatophyte infection. 8) For deep mycosis.

Chapter 43. Pathogenic Fungi To master Master the pathogenicity of Fungi. Course Contents 1. Types of mycoses (Fungal infectious diseases): 1) Superficial mycoses; Pityriasis versicolor, and Tinea nigra. 2) Cutaneous mycosis; Tinea corporis, Tinea capitis, Tinea pedis, Tinea cruris, Tinea unguium, and Tinea barbae. 3) Subcutaneous mycosis; chromoblastomycosis, sporotrichosis, mycetoma, Lobomycosis, and subcutaneous zygomycosis. 4) Systemic mycosis and distribution; Blastomycosis; Coccidioidomycosis; Paracoccidioidomycosis; and Histoplasmosis. 5) Opportunistic fungal infection; i. Candidiasis; Candida albicans. ii. Cryptococcosis; Cryptococcus neoformans. iii. Aspergillosis; Aspergillus. iv. Mucormycosis; Mucor. v. PCP; Pneumocystis carinii. 6) Hypersensitivity to Fungi and Mycotoxins

Ⅲ. Medical Microbiology Experiment Experiment 1-2 [Class Duration: 6hours] [Requirements] 1. Master the use of oil-immersion lens of microscope. 2. Master the techniques of sterilization. 3. Master the method and theory of gram stain. 4. Be familiar with the bacterial shape. [Contents] 190

1. Use oil-immersion lens of microscope. 2. Gram stain. 3. Observe the shape of bacteria.

Experiment 3-4 [Class Duration: 6hours] [Requirements] 1. Master the techniques for bacterial inoculation. 2. Be familiar with bacteria biochemistry phenomenon. [Contents] 1. Observation of the phenomenon of bacteria biochemistry. 2. Media for routine cultivation of bacteria. 3. Techniques for bacterial inoculation.

Experiment 5. [Class Duration: 3hours] [Requirements] 1. Master the method of antibiotics and disinfectants sensitive test. 2. Master the theory and disadvantage of sterilization of ultraviolet rays. 3. Be familiar with bacterial distribution from air and skin. [Contents] 1. Antibiotics and disinfectants sensitive test-paper disk method. 2. Bacterial cultivation from air and skin. 3. Sterilization of ultraviolet rays.

Experiment 6. [Class Duration: 4 hours] [Requirements] 1. Master the method of acid-fast stain. 2. Be familiar with the special structure of bacteria. [Contents] 1. Observation of special structure of bacteria. 2. Acid-fast stain.

Experiment 7-8 [Class Duration: 6 hours] 191

[Requirements] 1. Master the theory and result analysis of Widal test. 2. Be familiar with the process of identification of stool. 3. Be familiar with the morphology of enteric bacilli. [Contents] 1. Identification of enteric bacilli from clinical specimen (stool). 2. SS plate and KIA. 3. Morphology and IMViC test of enteric bacilli. 4. Widal test.

Experiment 9. [Class Duration: 3hours] [Requirements] 1. Master the process of coagulase test. 2. Be familiar with the morphology of staphylococcus. [Contents] 1. Coagulase test. 2. Morphology of staphylococcus.

Experiment 10. [Class Duration: 3 hours] [Requirements] 1. Master the process of the stain of fungi. 2. Be familiar with the morphology of fungi. [Contents] 1. Stain of fungi. 2. Morphology of fungi.

Ⅳ. Hours Distribution The ratio of teaching hours of theory to experiment is 2:1, 64 hours for theory, and 32 hours for experiment. Content Theory (hr) Content Experiment (hr)

General Bacteriology 15 Bacterial Morphological Observation 9

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Bacteriology 18 Culture and Biochemistry of Bacteria 6

Distribution, Disinfection, and Other Microbiology 6 3 Sterilization of Bacteria. Bacterial Cultivation and Laboratory Virology 25 9 Diagnosis for Bacterial Infection.

Fungal Morphological Observation. 3

Experimental Test 2

Ⅴ. Examination Pattern & Marks Distribution Examination Pattern: At the end of the course, the students will be evaluated by; 1. Their theory level of medical microbiology, 2. Attendance, and performance, 3. And experimental skills. Marks Distribution: 1. Attendance and performance- 5%; 2. Experimental skills; 1) Lab reports- 10%; 2) Experimental test- 5%; 3. Theory final examination- 80 %

Ⅵ. Textbook and References Text Book: Wang S. et al., Textbook of Medical Microbiology and Parasitology, First Edition, Peking, 2006. Reference Books: 1. Jawetz M. et al., Medical Microbiology, 22nd Edition, Norwalk: Appleton & Lange, 2004. 2. Patrick R. M, et al., Medical Microbiology, 3rd Edition, Mosby-year book Inc.1998. 3. Lansing M. et al., Microbiology, 5th Edition, WCB/Mc Graw-Hill, 2002. Journals: 1. The Journal of Infectious Diseases, 2. Journal of Emerging Infectious Diseases, 3. Journal of Medical Microbiology.

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Regional Anatomy

Credits: 3 Total hours: 72 Lectures hours: 24 Experiment hours 48 Grade: 3rd Semester: 1 Hai-Qin Lv Compiler: Email: [email protected]

Ⅰ. Preamble and Objectives Regional Anatomy (course 4102301) is one of the foundation subjects in medical study and is primarily designed for the preclinical medicine students. It deals with the form, position, layers and relationship of the structures of several systems located in a particular region of the body. On the base of having mastered the basic knowledge of systemic anatomy, this course will primarily focus on factual knowledge, comprehension, biomedical application, and analysis of how the component parts of an anatomical region function as a unit in that area of the human body. The purpose of this syllabus is to provide a guide to: 1. The course of instruction in this curriculum, and 2. Clear expectations of the anatomic content to be mastered, which will enable the students to obtain the knowledge of topographic anatomy (the composition, morphological and structural features, layers and relationship of the component parts of different anatomical regions of the body) and to lay a solid foundation for studying the other subsequent medical curriculums.

Ⅱ.Teaching and Learning Requirements: Regional anatomy is an important component of human anatomy which has a broad scope of application and is an indispensable subject of medical education. The teaching of regional anatomy should carry out the principle of combining the partial with the whole, shape with function, theory with practice. It includes both theory lectures and laboratory studies. Theory lectures introduce the component parts of an anatomical region of human body, and introduce the basic structures and relationship of the organs and their function by a multimedia medium. With the guidance of teachers, the laboratory studies will be carried out in groups. The students should have independent study skills

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and be responsible for factual and anatomical comprehension of the indicated elements in the book. The students need to cooperate with each other in the process of experiments to find out and recognize the indicated elements and understand how these component parts function as a unit in that area of the human body. Convenient to students’ studying the course, the main contents of the curriculum are arbitrarily divided into three kinds: “master”, “be familiar with” and “understand” which expect different approaches from students. 1. The “Master”- contents are the most essential and the most important contents, and students must be able to precisely memorize this category of contents and correctly paraphrase them. 2. The “be familiar with”- contents are the main contents, and students must know this second kind of contents. 3. The “understand”-contents belong to the general/common contents, and students only need to recognize and comprehend them.

Ⅲ. Contents and Requirements Introduction To be familiar with 1. The basic structures of the body. 2. The descriptive anatomical terms. To understand Parts and regions of the body.

Chapter 1. The Head To master 1. The layers of the scalp, the anatomical features of each layer and their clinical significance. 2. The position, structure, relations and clinical significance of the parotideomasseteric region. 3. The structures that vertically or transversally pass through the parotid gland. 4. The composition and function of the masticatory muscles. To be familiar with 1. The morphology and structure of the sellar region in the internal surface of the base of skull, the relations and clinical significance of the hypophysis. 2. The distributing characteristics of the blood vessels and nerves of the calvaria. 195

3. The course, distribution and features of the blood vessels of the face. 4. The distribution of the facial nerve. 5. The communications between the intracranial and extracranial veins, and the clinical significance of this communication. To understand 1. The boundaries of the head. 2. The skin and the superficial fascia of face. 3. The important anatomical landmarks of the head: the external occipital protuberance, mastoid process, zygomatic arch, supraorbital and infraorbital foramina, mental foramen, angle of mandible. 4. The position, fascial spaces, and communication of the infratemporal fossa.

Chapter 2. The Neck To master 1. The shape, location, relations, blood supply and innervation of the thyroid gland. 2. The boundaries and layers of the carotid triangle; the formation, contents and relations of the carotid sheath. 3. The layers of the cervical fascia: investing layer, pretracheal layer, carotid sheath and prevertebral layer. 4. The relations of the cervical part of the trachea, anatomical notes for tracheotomy. To be familiar with 1. The location and communication of the fascial spaces of the neck. 2. The location of the parathyroid glands. 3. The structures located deep to the sternocleidomastoid and their relationship. 4. The location and borders of the scalene fissure, the contents of the scalene fissure. 5. The formation and main contents of the submandibular triangle, supraclavicular triangle, and occipital triangle. 6. The location and structures of the root of neck. To understand 1. The regions of the neck and the main structures of each region. 2. The surface landmarks of the neck: the hyoid bone, thyroid cartilage, cricoid cartilage, sternocleidomastoid, spinous process of the 7th cervical vertebra, jugular/suprasternal 196

notch, and greater supraclavicular fossa. 3. The groups, position and clinical significance of the cervical lymph nodes.

Chapter 3. The Upper Limb To master 1. The origin, course, venous return, communication and clinical significance of the superficial veins (the cephalic vein and basic vein) of the upper limb. 2. The boundaries and contents of the axillary fossa; the groups, location, collecting area and lymphatic return of the axillary lymph nodes. 3. The origin and course of the radial nerve and the arteria profunda brachii, and the places where they are easily injured. 4. The ligaments formed by the deep fascia of the wrist; the structures passing through the superficial surface of the transverse carpal ligament and the carpal canal. 5. The formation, location and main branches of the superficial and deep palmar arches. 6. The distribution of the median nerve and ulnar nerve. 7. The boundaries and contents of the trilateral foramen and quadrilateral foramen. 8. The formation and contents of the humeromuscular tunnel. To be familiar with 1. The surface landmarks of the upper limb, the surface projection of the arteries and nerves of the upper limb. 2. The constructional features and clinical features of the shoulder. 3. The layers of the muscles in the anterior antebrachial region; the arrangement relationships of the structures of the carpal canal. 4. The morphological features and clinical significance of the radius, ulna and interosseous membrane. 5. The structural layers of the palm, the features of the deep fascia and fascia sheath of palm. 6. The structural features and clinical significance of the tendinous sheaths of fingers and the flexor and extensor tendons. 11. The myotendinous (rotator) cuff, the coracoacromial arch, the scapular anastomosis, the extensor retinaculum and the tendon of extensor digitorum. To understand 1. The distribution of the arteries and nerves of the anterior cubital region. 197

2. The anatomical base of the functional position of the hand. 3. The formation and clinical significance the palmar synovial bursae and spaces. 4. The characteristics of the skin and subcutaneous tissue of fingers.

Chapter 4. The Lower Limb To master 1. The origin, course, tributaries, communications, valves and clinical significance of the great and small saphenous veins. 2. The blood vessels and nerves that pass through the suprapiriform, infrapiriform foramina and lesser sciatic foramen respectively. 3. The course, branches and distribution of the sciatic nerve in the posterior region of thigh. 4. The composition and contents of the femoral triangle, lacuna musculorum, lacuna vasorum and femoral sheath. 5. The composition and clinical significance of the femoral canal. 6. The composition and contents of the adductor (Hunter) canal. 7. The boundaries, position and contents of the popliteal fossa, the positional relationships of the nerve and blood vessels in the popliteal fossa. 8. The formation, contents and clinical significance of the malleolar canal. To be familiar with 1. The surface landmarks of the lower limb, the surface projection of the arteries and nerves of the lower limb. 2. The location, groups, lymph collecting area and lymphatic return of the superficial inguinal lymph nodes. 3. The morphological and constructional features of the fascia lata, iliotibial tract, and saphenous hiatus. 4. The course and branches of the dorsal artery of the foot, the blood vessels and nerves of the sole of foot. 5. The structural features and clinical significance of the knee joint and hip joint. 6. The formation of the suprapiriform, infrapiriform foramina, and the lesser sciatic foramen; the relationships between the sciatic nerve and the piriformis. 7. The blood vessels and muscles of the posterior compartment of the leg. To understand 198

1. The course and distribution of the external pudendal arteries, superficial epigastric artery, and superficial iliac circumflex artery. 2. The course, branches and distributions of the obturator artery, vein and nerve in the medial region of thigh. 3. The course and clinical significance of the posterior tibial artery, peroneal artery, and tibial nerve. 4. The course of the anterior tibial artery, and deep peroneal nerve. 5. The function of the muscles of the lateral region of the leg, the course and supply of the superficial peroneal nerve.

Chapter 5. The Thorax To master 1. The structure, blood supply and lymphatic drainage of the female breast; the relationship between the mammary lymphatic drainage and mammary carcinoma. 2. The shape, lobes and segments of lung. 3. The definition of the hilum of lung, root of lung, and segment of lung. 4. The arrangement of the structures within the hilum of lung; the relations of the root of lung. 5. The relations and branches of the aortic arch; the relationship between the artery ligament, and the left vagus nerve and the left recurrent laryngeal nerve. 6. The concepts of the pericardium and pericardial cavity; the location and relations of the transverse sinus of pericardium and oblique sinus of pericardium. 7. The internal structure of the heart. 8. Divisions, contents and relations of the mediastinum. To be familiar with 1. The layers of the thoracic wall, the segmental and overlay distribution of the thoracic cutaneous nerves and its clinical significance. 2. The structures of intercostal spaces, the arrangement relationship of the intercostal nerves and intercostal blood vessels and its clinical significance. 3. The course and clinical significance of the internal thoracic artery. 4. The composition of the pleura cavity; the location and clinical notes of the cupula and pleura recesses; surface projections of the pleurae and lungs. 5. The concept of the mediastinum; the boundaries, location and divisions of mediastinum. 199

6. The structures of the superior mediastinum and their relationship. 7. The origin, termination, course, main relations and clinical significance of the structures of the posterior mediastinum. To understand 1. The boundaries and main reference lines of the thorax. 2. The superficial and deep fasciae of the thoracic wall, the distribution of the muscles of the thoracic wall. 3. The surface projection of the heart and its clinical significance. 4. The relations and clinical significance of the heart, esophagus, thoracic aorta and thoracic duct.

Chapter 6. The Abdomen To master 1. The layers, structural features and clinical significance of the anterolateral abdominal wall; the formation of the sheath of rectus abdominis. 2. The position, formation and contents of the inguinal canal; the composition of the spermatic cord. 3. The location, shape, relations, nerve distribution and blood supply of the stomach. 4. The location, morphology, structure, parts and relations of the duodenum. 5. The location and clinical significance of the suspensory ligament of duodenum (Treitz’s ligament). 6. The location, surface projection and relations of the liver. 7. The composition of the hepatic pedicle, the arrangement relationship of the structures of hepatic pedicle and its significance. 8. The concepts and clinical significance of the Glisson system and segment of liver. 9. The composition of the extrahepatic bile ducts, the parts of the common bile duct and the relations of each part. 10. The relations and clinical significance of the head of pancreas. 11. The location of the vermiform appendix; the surface projection of the root of vermiform appendix; the method of looking for the vermiform appendix. 12. The composition and main tributaries of the hepatic portal vein; the features of the portal system; the anastomoses between the hepatic portal vein and the venae cavae, and the 200

significance of the anastomoses under the condition of portal hypertension. 13. The location and relations of the kidneys and its clinical significance. 14. The course of the ureters; the location of the constrictions of the ureters; the relationship between the narrows and ureteral stones. To be familiar with 1. The concepts of peritoneum and peritoneal cavity. 2. The names and positions of the structures formed by the peritoneum; the divisions of the peritoneal cavity; some important peritoneal spaces and their clinical significance. 3. The relationship of various organs to their peritoneal coverings in the abdominal and pelvic cavities. 4. The boundaries of the inguinal region and the inguinal triangle; the features of inguinal region, and the relationship between the features of inguinal region and the formation of inguinal hernia. 5. The anatomical basis of the hernias and the differences between the direct inguinal hernia and indirect inguinal hernia. 6. The shape, parts and location of the pancreas. 7. The boundaries and clinical significance of the triangle of Calot. 8. The characteristics of the arterial distribution of the jejunum and ileum and its significance in the resection and anastomosis of the intestine. 9. The blood supply of the colon; the anatomic features and clinical significance of the middle colic artery. 10. The location and relations of the spleen. To understand 1. The boundaries, regions and surface markings of the abdomen; the surface projections of the abdominal visceral organs. 2. The anatomic basis of the surgical treatment of portal hypertension. 3. The anatomic basis of the subtotal stomach ectomy. 4. The variation of the gallbladder, cystic duct, and cystic artery. 5. The position, boundaries and important contents of the retroperitoneal space, the clinic significance of the retroperitoneal space for extraperitoneal operations.

Chapter 7. The Pelvis and Perineum 201

To master 1. The position and relations of the urinary bladder and the prostate. 2. The position, relations and ligaments of the uterus. 3. The course of the uterine artery, the positional relationship between the uterine artery and the ureter. 4. The relationship between the location of the ovary and uterine tube, and the broad ligament of uterus. 5. The shape, structure, location, relations, innervation, blood supply and lymph drainage of the rectum and anal canal. 6. The formation of the urogenital diaphragm; the composition of the superficial and deep perineal spaces; the rupture of the urethra and the urinary extravasation in male. To be familiar with 1. The location and distribution of the sacral plexus, and pelvic splanchnic nerves. 2. The composition of the urogenital triangle, and the anal triangle. 3. The name, location, communication and clinical significance of the perineal spaces. 4. The concept of pelvic diaphragm, the composition of the pelvic diaphragm. 5. The location, boundaries, contents and clinical significance of the ischioanal (or ischiorectal) fossa. 6. The importance of the sphincter ani externus to the formation of the anorectal ring. To understand 1. The distribution of the pelvic visceral organs and their relationship with the peritoneum. 2. The boundaries, regions and surface landmarks of the pelvis and perineum. 3. The muscles of the pelvic floor and pelvic wall; the composition of the pelvic fascia. 4. The blood supply and lymphatic drainage of the ovary and uterine tube. 5. The layers of the structures located in the superficial and deep perineal spaces; the origin, course and distribution of the blood vessels and nerves of the perineum.

Chapter 8. The Back and Vertebral Region To master 1. The formation, contents and clinical significance of the superior lumbar triangle, inferior lumbar triangle, and triangle of auscultation. 2. The composition and features of the vertebral canal; the composition of the walls of 202

vertebral canal; the relations and clinical significance of the walls of vertebral canal. 3. The boundaries, contents and clinical significance of the epidural space and subarachnoid space. To be familiar with 1. The concept of the layers of the vertebral region. 2. The course and distribution of the occipital artery, vertebral artery, accessory nerve, and thoracodorsal nerve. 3. The anatomic features of the spinal dura mater, spinal arachnoid mater, and spinal pia mater. To understand 1. The boundaries, divisions and important surface landmarks of the vertebral region. 2. The anatomical features of the deep fascia of the back. 3. The composition and communication of the internal vertebral venous plexus.

Ⅳ.Ability Training Requirements Upon the successful completion of Human Anatomy, students should obtain: 1. A factual comprehension of the major anatomical divisions (e.g., the thorax, or upper limb) emphasizing the functional relationships of the various systemic structures (e.g., muscles, nerves, and arteries) within that area. 2. An understanding of the morphological role of the different body regions, in the context of adjacent regions, and the body as a whole. 3. The ability to use regional anatomical knowledge to understand the anatomical origin of real-life biomedical problems.

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Ⅴ. Hours Distribution Total teaching hours are 72- with 24 hours spent on the theory lectures, and 48 hours on the Lab studies.

Contents Lecture Lab The Head 2 4 The Neck 2 4 Thoracic wall, Axillary fossa 2 4 The Thorax Cavity 2 4 Anterior Region of The Upper Limb 2 4 Posterior Region of The Upper Limb 2 4 Anterior Region of The Lower Limb 2 4 Posterior Region of The Lower Limb 2 4 Abdominal wall 2 4 Abdominal cavity 3 6 The Pelvis And Perineum 1 2 The Back And Vertebral Region 2 4

Ⅵ.Assessment Lab (Quizzes) 50% Final Exam 50% Total 100%

One final written exam will be given after the completion of the subject. The students will be grouped during the lab time and the members of each group are asked to cooperate with each other. Five quizzes will be given during the lab studies and the students of each group will be randomly chosen for the quiz each time. The points obtained by the chosen students will represent their group’s marks for a given quiz. For example, all the members of the group will get 10 points for a given quiz if the chosen student gets 10points; on the other hand, all the members of the group will get no point if the chosen student is absent or gets zero on the day of the quiz. The comprehensive score of a student is eventually determined by the manual evaluations of his/her marks obtained in

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the above quizzes and exam. The total points obtained in the quizzes will make up 50% of the final comprehensive score and the mark(s) obtained in the final written exam will make up 50% of the final comprehensive score.

Ⅶ. Textbook and References Text Book Huaijing Wang and Baogui Su, eds. 2006. A Textbook of Regional Anatomy, 5th edition, Changchun: Jilin Science and Technology Press. Reference Books: 1. Richard L Drake, Wayne Vogl, and Adam W.M.Mitchell, eds. 2010. Gray’s Anatomy for Students, 2nd edition, London: Churchill Livingstone. 2. Keith L Moor, Arthur F Dalley and Anne MR Agur, eds. 2009. Clinically Oriented Anatomy, 6th edition, Lippincott Williams & Wilkins.

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Pharmacology

Credits: 6.5 Total hours: 128 Lectures hours: 80 Experiment hours 48 Grade: 3rd Semester: 2 Xiao-Dong Wu Hua Liu Hong-Wei Yi Compilers: Lei Zhao Xin-Jian Zhu Email: [email protected]

Preface Pharmacology is the science of studying the rule and mechanism of mutual interactions between drugs and living systems including human species, animals, parasites, microorganisms, and tumors. Pharmacology is a significant basic course in medical education and also a double bridge that links medicine and pharmacy, and basic medicine and clinical medicine. Pharmacology is characterized by wide range of contents and profound theories. Students of pharmacology must have detailed working knowledge of those areas in which biological or chemical therapeutics play a role. These may include (but are not limited to): biochemistry, molecular biology, genetics, chemical biology, physiology, chemistry, neuroscience, and microbiology. The aim of this course is to make students master the features of clinical drugs commonly used in the hospital. The course will provide basic theory and knowledge for clinical rational use of drugs in prevention and treatment of diseases and lays a solid theoretical foundation for the subsequent clinical courses. Convenient to students’ studying the course, the main contents of the curriculum are arbitrarily divided into three kinds: “master”, “be familiar with” and “understand” which expect different approaches from students. 1. The “Master”- contents are the most essential and the most important contents, and students must be able to precisely memorize this category of contents and correctly paraphrase them. 2. The “be familiar with”- contents are the main contents, and students must know this 206

second kind of contents. 3. The “understand”-contents belong to the general/common contents, and students only need to recognize and comprehend them.

Ⅰ. Preamble and Objectives The objective of studying pharmacology is to: 1. Understand the general principles of drug action, handling of drugs by the body and underlying mechanism. 2. Prescribe drugs rationally by understanding drugs based on suitability, tolerability, and interaction between dugs. 3. Apply pharmacokinetic principles in clinical practice pertaining to the drugs used in commonly encountered conditions and emergency medical conditions. 4. Foresee, prevent and manage adverse drug events and drug interactions. 5. Use antimicrobials judiciously for therapy and prophylaxis. 6. Understand the basic concepts of new drug development with emphasis on design and conduct of clinical trials and interpretation of their results.

Ⅱ. Contents and Requirements Chapter 1. Introductio To master: 1. Concepts of Pharmacology, drug, pharmacodynamics, and pharmacokinetics. To be familiar with: 1. The significance and the task of Pharmacology. 2. A general method and principle of learning pharmacology. To understand: Source of drugs, and the history of pharmacology.

Chapter2. Pharmacokinetics To master: 1. Concepts of First-pass Effect, Enzyme inhibitors, Enzyme inducers, Entero-hepatic recycling, Clearance (CL), Apparent Volume of distribution (Vd), K (Elimination rate constant), Bioavailability (F), half-life time (t1/2), 207

2. The features of first order kinetics and Zero order kinetics. To be familiar with: 1. Characteristics of simple diffusion. 2. The influence of the pH of body fluid on drug distribution, 3. The influence of plasma protein binding on drug distribution, 4. Biotransformation of drugs, 5. Features of CYP450 enzyme system. 6. Area under the curve (AUC), 7. Steady-state concentration (Css), 8. Classical compartment model, 9. Loading dose. To understand: 1. Routes of administration, 2. Results of two phase of biotransformation, 3. The influence of physiological barriers on drug distribution, 4. Process of drugs in the body. 5. Types of Drug transportation, Filtration, and Carrier-Mediated Membrane Transport.

Chapter 3. Pharmacodynamics To master: Concepts of therapeutic effects, adverse reactions, side effects, toxic effects, allergic reactions, residual (after) effect, idiosyncratic reactions, secondary reaction, drug tolerance, drug dependence, physical dependence, potency, efficacy, psychological dependence, therapeutic index (TI), pD2, pA2, agonist, antagonist, and partial agonist. To be familiar with: 1. Concepts of dose-response relationship, Emax, EC50 or ED50, safety range, certain safety factor, 2. Receptors, characteristics of binding with receptor, occupation theory, competitive antagonist, non-competitive antagonist, up-regulation of receptor, and down regulation of receptor. To understand: Etiological therapy, symptomatic therapy, replacement therapy, inverse agonist, classification of receptors, and selectivity of drug action. 208

Chapter 4. Factors Affecting Drug Effects To master The long-term use of the drug-induced body reaction changes: tolerance, addiction, dependence, and withdrawal phenomena. To be familiar with 1. Factors affecting drug effects; drugs; drug formulation and route of administration; drug interactions; pharmacodynamics and pharmacokinetic organism; 2. Physiological factors including age, gender, and genetic factors (drugs gene polymorphism), 3. Pathological factors; disease states (especially liver and kidney dysfunction drug action), 4. Psychological factors; the definition of placebo and drug clinical trials. To understand The principles of rational drug use.

Chapter 5. Efferent Nervous System Pharmacology To master The physiological function of efferent nervous system (ENS), the drugs classification of ENS, and the basic mode of ENS drug’s action. To be familiar with 1. The classification of ENS receptor; muscarinic receptor (M1, M2, M3) and nicotinic receptor

(NM, NN); α (α1, α2) and β (β1, β2) adrenergic receptors. 2. The biosynthesis, storage, release and metabolism of norepinephrine and acetyl choline. 3. The major function of every receptor and its mechanism.

Chapter 6. Cholinoceptor Agonist To master The effect of pilocarpine on the eye and glands, as well as the clinical uses of pilocarpine. To be familiar with The effect of acetyl choline on M and N receptor.

Chapter 7. Anticholinesterase Drugs and Cholinesterase Reactivators To master: 209

1. The pharmacologic effects, mechanism, clinic uses, and major adverse effects of neostigmine. 2. The mechanism of atropine and pralidoxime used to rescue organophosphate intoxication. To be familiar with: The mechanism of organophosphate inhibiting cholinesterase, and its resulting toxic symptoms.

Chapter 8. Cholinoceptor Antagonist (I) – M-receptor Antagonist To master: The pharmacological effects, and clinic uses of atropine. To be familiar with: 1. The major adverse effect of atropine. 2. The clinic uses of anisodamine and scopolamine. To understand: The characteristic of homatropine, tropicamide, and propantheline bromide.

Chapter 9. Cholinoceptor Antagonist (II) – N Receptor Antagonist To master: The mechanism, action, characteristic, and clinical uses of depolarizing muscular relaxants such as suxamethonium, and non-depolarzing muscular relaxants such as tubocurarine. To understand: The effect and major clinical use of ganglionic blocking agents.

Chapter 10. Adrenergic Receptor Agonist To master: The pharmacologic effect, clinical use and adverse effect of norepinephrine, epinephrine, dopamine, and isoprenaline. To be familiar with: The major characteristic and uses of ephedrina and dobutamine. To understand: The clinical uses of phenylephrine, metarminol, and methoxyamine.

Chapter 11. Adrenergic Receptor Antagonist To master 210

1. The classification of α-receptors antagonist, 2. The major pharmacologic effect and clinical uses of α-receptor antagonists. 3. The major pharmacologic effect, clinical uses, and adverse effects of β-receptors antagonist. To be familiar with Β-receptors classification and pharmacokinetics. To understand: The characteristics of propranolol, pindolol, atenolol, metoprolol, timolol, and labetalol.

Chapter 14. Local Anesthetic To master 1. The effect and mechanism of local anesthetics. 2. The factors that influence the effect of local anesthetics. To understand The characteristic and clinic uses of procaine and lidocaine.

Chapter 15. Sedative Hypnotic Drugs To master The pharmacologic effect, clinic uses, and adverse effects of Benzodiazepines such as diazepam. To be familiar with: The pharmacologic characteristic and clinical uses of barbiturates. To understand: New sedative hypnotic drugs.

Chapter 16. Antiepileptics and Anticonvulsants To master The pharmacologic effect and characteristic of phenytoin, phenobarbitone, ethosuximide, benzodiazepines, sodium valproate, and carbamazepine. To be familiar with The pharmacologic effect and clinical uses of magnesium sulfate with different administration.

Chapter 17. Antiparkinsonian Drugs To master 211

1. The type and mechanism of antiparkinsonian drugs. 2. The pharmacologic effect and clinic uses of levodopa, 3. The mechanism of levodopa used with carbidopa. To be familiar with The characteristic of amantadine and bromocriptine. To understand The pathologic mechanism of parkinsonism.

Chapter 18. Psychotolytic To master The pharmacologic effect, mechanism, clinic uses and adverse effect of chloropromazine. To be familiar with 1. The classification of psychotolytic. 2. The classification and mechanism of anti-depression drugs. To understand 1. The pathologic mechanism of schizophrenia, mania, and depression. 2. The pharmacologic effect, mechanism and clinic uses of lithium carbonate.

Chapter 19. To master The pharmacologic effect, mechanism, clinic uses and adverse effect of morphine. To be familiar with: 1. The difference between morphine and pethidine, and the clinic uses of pethidine. 2. Opiate receptor, endogenous opiate-like substance. 3. The pharmacologic effect and clinic uses of opiate receptor antagonist, such as naloxone. To understand The pharmacologic characteristic and clinic uses of other analgesics.

Chapter 20. Antipyretic-Analgesic and Anti-Inflammatory Drugs To master 1. The common mechanism of antipyretic-analgesic and anti-inflammatory drugs. 2. The pharmacologic effect, clinic uses, and adverse effect of aspirin. 212

To be familiar with 1. The characteristic of paracetamol, phenylbutazone, indomethacin, and ibuprofen. 2. The characteristic of aspirin pharmacokinetics.

Chapter 21. Antiarrhythmic Drugs To master 1. Classification of antiarrhythmic drugs and all kinds of drugs electrophysiological characteristics and representativeness of drugs. 2. The main clinical uses and major adverse reactions of Quinidine, procainamide, lidocaine, phenytoin, amiodarone, and verapamil. To be familiar with Pharmacokinetic processes of quinidine, procainamide, lidocaine, phenytoin, amiodarone, and other drugs. To understand 1. Physiologic features of cardiac pathogenic mechanism of the arrhythmias. 2. Other characteristics of anti-arrhythmic drugs.

Chapter 22. Renin and Angiotensin To master 1. Effects and mechanism of Angiotensin-converting enzyme (ACE) inhibitors, 2. Effects and mechanism of angiotensin-II receptor 1 antagonist. 3. The characteristic and main adverse reactions of Angiotensin-converting enzyme inhibitors and angiotensin II receptor 1. To be familiar with The roles of Renin-angiotensin-aldosterone system (RASs) in physiology and cardiovascular diseases. To understand Other drugs acting on renin angiotensin aldosterone system, such as inhibitors of renin, aldosterone antagonists.

Chapter 23. Diuretics To master 213

1. High efficacy diuretics (loop diuretics): furosemide and bumetamide, pharmacological effects, characteristics: high efficacy fast onset. a. Inhibit Na+-K+-2Cl- co-transport system in the thick ascending limb of loop of Henle in medulla and contex, Inhibit concentrating and diluting function of kidney. b. Clinical uses: used to treat severe edema, acute pulmonary edema and cerebral edema, renal failure, and chemical intoxication (to increase urine flow). c. Adverse effects: Ototoxicity, Hypokalemia, Hypomagnesemia, and Hyperuricemia; 2. Moderate efficacy diuretics (thiazides or thiazide-like diuretics): primary site of action is at distal convoluted tubule, and inhibit Na+-Cl-co-transport. a. Hydrochlorothiazide, pharmacological effects, clinical uses and untoward effects; 3. Low efficacy diuretics (potassium-sparing diuretics): triamterence, and amiloride: a. Pharmacological characteristic, clinical uses, and untoward effects. b. Osmotic diuretics; mannitol, dehydration effects of clinical uses, and side effects. To be familiar with The concept of diuretics; urinary physiological process; glomerular filtration, reabsorption, and secretion of tubes and function of collective tubes.

Chapter 24. Drugs Used for Therapy of Hypertension To master 1. The classification of anti-hypertensive drugs, 2. The representative drugs in each class and their main features and applications. 3. The effects and mechanism of first line drugs for anti-hypertension such as Thiazide diuretics, angiotensin-converting enzyme inhibitors, adrenaline β-receptor blockers, and calcium antagonists; their characteristics, clinical application, and adverse reactions. To be familiar with Clonidine, Methyldopa, Hydralazine, Sodium Nitroprusside, Minoxidil, Guanethidine, and Reserpine, along with their mechanism, clinical applications, and major adverse reaction. To understand 1. The application of the principles of the anti-hypertensive drugs. 2. Characteristics of other antihypertensive drugs, and application principles of antihypertensive drug

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Chapter 25. Pharmacotherapy of Congestive Heart Failure To master 1. Effects and mechanism of cardiac glycosides, their clinical applications, and adverse reactions. 2. Effects and mechanism of Angiotensin-converting enzyme inhibitor Captopril (Captopril) and angiotensin II receptor (AT1) antagonist in treating congestive Heart Failure. 3. Effects and the application of β-blockers and Diuretics in the treatment of heart failure and their adverse reaction. 4. The classification of anti-chronic heart failure drugs. To be familiar with 1. Pharmacokinetics of cardiac glycoside, roles of renin-angiotensin-aldosterone system (RASs) in chronic heart failure, 2. Effects of vasodilator drugs in the treatment of heart failure. 3. The characteristics of Amrinone and vesnarinone. To understand Other drugs in the treatment of heart failure.

Chapter 26. Treatment of Myocardial Ischemia To master 1. Classification of anti-anginal drugs and the representativeness of the drugs. 2. Anti-anginal effects and characteristics of nitrates, beta-blockers and calcium antagonists, their applications. 3. Reasons for using β-blockers in combination with nitrates in treating the angina. To be familiar with Effect of fatty-acid oxidation (pFox) inhibitors in treating ischemic diseases. To understand Factors acting myocardial oxygen supply and oxygen consumption,

Chapter 27. Drugs for Therapy of Dyslipidemia and Anti-Atherogenic To master 1. Anti-atherosclerosis drug’s classification and the representative drugs. 2. AMG-COA reductase inhibitors, bile acid binding resins, nicotinic acid, and phenoxy acids and lipids role and application. 215

To be familiar with 1. Etiology of arterial atherosclerosis, along with it’s pathology. 2. Antioxidants polyene fatty acids, and other anti-atherosclerotic drugs.

Chapter 28. Anticoagulants, Coagulants and Antianemia Drugs To master 1. Anticoagulants such as heparin along with it’s pharmacological effects, clinical uses, and untoward effects. 2. Coumarin; warfarin, and dicumarol. Their action, characteristics, clinical uses and untoward effects of drugs. 3. Anti-platelet aggregation drugs; such as aspirin; To be familiar with The mechanism of blood coagulation and anticoagulation. Anticoagulants; heparin; source and chemistry, To understand 1. Coagulants such as vitamin K with it’s pharmacological effects, and uses. 2. Anti-fibrinolytics; the pharmacological effects, clinical uses and untoward effects of aminomethylbenzoic acid and tranexamic acid; 3. Antianemia drug; clinical uses, untoward effects of ferrous sulfate, iron dextran, ferric ammonium citrate, folic acid, and vitamin B12. 4. Plasma expander; dextran, expand the blood volume, improve microcirculation, diuresis, anticoagulant effect, and it’s clinical uses.

Chapter 29. Histamine and Anti-Histamines To master 1. The pharmacological effects and clinical uses of antihistamine drugs (H1 and H2 antagonists). 2. Main untoward effects. To be familiar with The different Histamine receptors. To understand 1. The relationship between histamine and allergy. 2. Synthesis, storage, and release of histamine. 216

Chapter 30. Drugs Affecting Respiratory System To master Mechanism of action, and clinical uses of the following drugs; Bronchodilators (Beta-adrenergic agonists, theophylline), Anti-cholinergics (ipratropine), Mast cell stabilizers, and adrenal cortical hormone (Inhaled Corticosteroids). To be familiar with The classification of anti-asthmatic drugs. To understand: Drugs used to treat cough, and the mechanism of anti-leukotrienes action.

Chapter 31. Drugs Affecting the Gastrointestinal System To master Drugs used to treat peptic ulcer:; antimicrobial agent (antibiotic); proton pump inhibitors (omeprazole); histamine (H2) receptor antagonists (Cimetidine, Ranitidine); anticholinergics (Atropine); prostaglandins (Misoprostol); antacids (Aluminum hydrogen); mucoprotective drugs (Sucralfate). To be familiar with The classification of drugs used to treat peptic ulcer. To understand Drugs for motility disorders: digestives, antiemetics, purgatives, antidiarrheals, and cholagogues.

Chapter 34. Adrenocortical Hormones To master 1. The main physiological actions and pharmacological actions of glucocorticoids, clinical uses, adverse effects, and cautions. 2. Pharmacological action of anti-inflammatory actions, immunosuppressive effect. Anti-shock actions, effect on the formed elements of blood, effect on central nerve system. 3. Elucidate the manifestations of these actions and the reasons of them respectively, anti-inflammatory actions and immunosuppressive effects based on advantage and disadvantage aspects. 4. Clinical uses of glucocorticoids; severe infections, relieve symptoms; inflammation; allergic 217

disorders; and autoimmune disorders; shock, hematologic diseases. 5. Substitution therapy, local applications form dermatologic disease. 6. Adverse effects; similar to the symptom of hyperfunction of adrenal cortex, long term administration result in insufficiency of adrenal cortex, induce or exacerbate infection, induce peptic ulcers, and prolong wounded healing. To be familiar with 1. Pharmaceutical classification, structure-activity relationship; physiological action; regulating metabolism of carbohydrate, protein, lipid, water, and electrolyte. 2. Advantages and disadvantages of using glucocorticosteroids. To understand 1. Mineralocorticoids; pharmacological actions and clinical uses; 2. Mechanism of glucocorticoids; cytoplasmic receptor, combined with DNA in nucleus, activation of transcription, and synthesis of new proteins.

Chapter 35. Agents Affecting the Thyroid Gland To master 1. Mechanism of actions of thyroid gland agents, clinical uses, adverse effect and caution. 2. Antithyroid agents; Thioureas; methylthiouracil propylthiouracil tapazole carbimazole; inhibit peroxidase, block oxidation of iodide, and inhibit iodination of tyrosine, as well as block synthesis of thyroid hormone. Used to treat hyperthyroidism. 3. Adverse effects and caution; Iodine/Iodide; used to treat endemic goiter and hyperthyroidism; 4. Radioactive iodine; for diagnosis and therapy of hyperthyroidism; 5. β-adrenergic blocking drugs; 6. Characteristic of propranolol, used to treat hyperthyroidism. To be familiar with 1. Hypothalamus and hypophysis. 2. Action on growth and differentiation of cells. 3. And on energy metabolism, clinical uses, and adverse effect. To understand Biochemistry and physiology of thyroid hormones; synthesis, storage, and secretion of thyroid hormone.

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Chapter 36. Insulin and Oral Hypoglycemic Drugs To master 1. Mechanism of action of insulin, clinical uses, and adverse effects. 2. Oral hypoglycemic agents; sulfonylureas (tolbutamide chlorpropamide glibenclamide), 3. Direction stimulation of insulin release from the B-cell. 4. Treatment of patients suffering from typeⅡdiabetes. a. Biguanides; hyperglycemia with refractory obesity and combined with sulfonylureas in typeⅡdiabetes cause lactic acidosis. b. Thiazolidinediones (Glitazones); act by enhancing peripheral insulin sensitivity at muscle and adipose tissue, via activation of PPARγ. c. Alpha-Glucosidase Inhibitors (Acarbose); act by delaying carbohydrate absorption. To be familiar with 1. Dose principle; short-acting insulin (regular insulin); 2. Intermediate-acting insulin (insulin zinc suspention amorphous); 3. Long-acting insulin (insulin zinc suspension ), 4. Principle for selection of drugs. To understand 1. Biochemistry of insulin. 2. Enhance glycogenesis and glycolysis, regulate carbohydrate metabolism. 3. Insufficiency of insulin results in diabetes.

Chapter 37. Antimicrobial Agents To master The definition of chemotherapy index (CI). To be familiar with 1. The concept of chemotherapeutic drugs, antimicrobial agents, antibiotics, antimicrobial spectrum, bacteriostatic drugs, bactericidal drugs, and minimal inhibitory concentration (MIC). 2. The mechanism of antimicrobial agents action. To understand The structure of bacteria, the mechanism of bacterial resistance, the therapy with combined antimicrobial agents, and the relationship of Host-Drug-Pathogen.

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Chapter 38. Beta-Lactam Antibiotics To master 1. The classification of β-lactam antibiotics, 2. The mechanism of these drugs action, the adverse reactions of penicillins, and the antimicrobial characteristics of four-generation cephalosporins. To be familiar with 1. The basic structure of β-lactam antibiotics, 2. And the main characteristics of penicillins. To understand The mechanism of bacterial resistance and other β-lactam antibiotics.

Chapter 39. Aminoglycosides and Spectinomycin To master The mechanism of Aminoglycosides action, the antimicrobial characteristics, and the adverse reactions of Aminoglycosides. To be familiar with The basic structure and antibacterial spectrum of Aminoglycosides. To understand The mechanism of bacterial resistance and the individual aminoglycosides.

Chapter 40. Macrolides, Clindamycin and Polypeptide Antibiotics To master The mechanisms of three antibiotics action and the major clinical uses of three antibiotics. To be familiar with The antibacterial spectrum of three antibiotics and the adverse reactions of three antibiotics. To understand The mechanism of bacterial resistance and the individual macrolides.

Chapter 41. Tetracyclines and Chloramphenicol To be familiar with The antimicrobial activity and the adverse reactions of two antibiotics. To understand 220

The mechanism of bacterial resistance and clinical uses of two antibiotics.

Chapter 42. Artificial Synthetic Antibacterial Drugs To master 1. The mechanisms of Sulfonamides, Trimethoprim, and Quinolones action, 2. The major clinical uses of Sulfonamides and Quinolones, 3. And the cause of combination with trimethoprim and sulfamethoxazole. To be familiar with The basic structure, the antibacterial spectrum and the adverse reactions of Sulfonamides and Quinolones. To understand: 1. The mechanism of bacterial resistance and the individual Quinolones.

Chapter 43. Antiviral Agents and Antifungal Agents To understand 1. The categories of antiviral agents. 2. The antiviral activity, clinical uses and adverse effects of several categories of antiviral agents. 3. The categories of antifungal agents. 4. The antifungal activity, clinical uses and adverse effects of several categories of antifungal agents.

Chapter 44. Anti-mycobacterial Drugs To master 1. The classification of the first-line anti-tuberculous drugs; isoniazid, rifampin, pyrazinamide, ethambutol, and streptomycin. 2. The antibacterial characteristics of isoniazid and rifampin and the mechanism of rifampin action. To be familiar with The antibacterial characteristics of pyrazinamide, ethambutol, and streptomycin. To understand: The second-line anti-tuberculous drugs and the adverse reactions of the first-line anti-tuberculous drugs. 221

Chapter 45. Anti-Parasitic Drugs To master 1. The classification of the antimalarial drugs; tissue schizonticides, blood schizonticides, and gametocides. 2. Antimalarial action of Chloroquine, Primaquine, and Pyrimethamine. To be familiar with Three stages of malarial life cycle; exoerythrocytic stage, endoerythrocytic stage, and sexual stage. To understand Clinical uses and adverse effects of antimalarial drugs.

Chapter 46. -Antineoplastic Agents To master The biochemical mechanisms of anticancer drugs; 1) Block nucleic acid biosynthesis, 2) Directly influence the structure and function of DNA, 3) Interfere with transcription and block RNA synthesis, 4) Interfere with protein synthesis and function, 5) Influence hormone homeostasis. To be familiar with: 1. The classification of anticancer drugs, 2. The cell cycle of cancer cells, 3. And the most common toxicities of anticancer drugs. To understand: The mechanism of anticancer drug resistance and the individual anticancer drugs.

Ⅲ.Practice Requirements Students are required to have a: 1. Basic knowledge of physiology, and basic skills of physiological experiments. 2. Basic knowledge of biochemistry, and basic skills for biochemical experiments. 3. Basic knowledge of pathology.

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Ⅳ. Ability Training Requirements Upon completion of this subject, students will be able to: 1. Enhance their experimental skills, design ability, and the cultivation of scientific thinking. 2. Calculate the dosage of a drug to be given, 3. Understand how to obtain the ED50 and LD50 of a drug from experiments. 4. Obtain the t1/2 and some other pharmacokinetics parameters in one-compartment model. 5. Create the models of general titanic convulsion on mice and test the drug’s anti-convulsional effects, and to create the models of aggressive mice and test the sedative effect of a drug. 6. Learn methods of detecting potency of diuretics. 7. Carry out hemodynamic experiments, model acute heart failure, and observe the drug’s effect.

Ⅴ. Hours Distribution Content Lecture Lab 80 40 Chapter 1 Introduction Chapter 2 Pharmacokinetics 12 8 Chapter 3 Pharmaeodynamies Chapter 4 factors affecting drug’ effect Chapter 5 Overview of the Autonomic and Somatic Motor Nervous Systems Chapter 6 Cholinergic Receptor Agonists Agents Chapter 7 Anticholinesterase Agents and Reactivators Chapter 8 Cholinergic Receptor Antagonists Agents ( I ) - Muscarinic 12 8 Receptor Antagonists Agents Chapter 9 Cholinergic Receptor Antagonists Agents ( H ) - Neuromuscular and Ganglionic Blocking Drugs Chapter 10 Adrenergic Agonists Chapter11 Adrenergic Receptor Antagoinists Chapter12 Drugs Acting of the Central Nervous System Chapter13 General Anesthetics Chapter14 Local Anesthetics 12 8 Chapter15 Hypnotics and Sedatives Chapter16 Pharmacotherapy of the Epilepsies

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Chapter17 Treatment of Central Nervous System Degenerative Disorders Chapter18 Antipsychoses Agents Chapter19 Opioid Analgesics Chapter20 Analgesic-Antipyretic and Antiinflammatory Agents Chapter21 Antiarrhythmic Drugs Chapter22 Renin and Angiotensin Chapter24 Drugs Used for Therapy of Hypertension Chapter25 Pharmacotherapy of Congestive Heart Failure 15 8 Chapter 26 Treatment of Myocardial Ischemia Chapter 27 Drug for Therapy of Dyslipidemia and Antiatherogenic Chapter23 Diuretics Chapter23 Diuretics Chapter28 Drugs Acting on the Blood and the Blood-Forming Organs Chapter29 Drugs that Effect Self-Activity 9 8 Chapter30 Pharmacotherapy of Asthma Chapter31 Drugs Affecting Gastrointestinal Function Chapter34 Adrenocorticosteroids Chapter35 Thyroid and Antithyroid Drugs 6 Chapter36 Insulin Oral Hypoglycemic Agents and the Pharmacology of the Endocrine Pancreas Chapter37 Overviews of Antimicrobial Therapy Chapter38 B-Lactam Antibiotics Chapter39 Macrolides Clindamycin and Polypeptide Antibiotics Chapter40 Aminoglycosides Chapter41 Tetracyclines chloramphenicol Chapter42 Artificial Synthetic Antibacterial Drugs 15 Chapter43 Antiviral Agents and Antifungal Agents Chapter44 Chemotherapy of Tuberculosis Mycobacterium Avium Complex Disease and Leprosy Chapter45 Chemotherapy of Parasitic Infections Chapter46 Antineoplastic Agents

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Ⅵ. Assessment Attendance and Performance 10% Phase check 10% Pharmacology experiments 20% Final Test 60% Total 100%

Ⅶ. Textbooks and References Textbooks 1. Pharmacology by Zhou Honghao 周宏灏卫生部教材英文版 2008 年 10 月，ISBN 978-7-117-10268-1/ 2. Fundamental Medical Pharmacology (Second Edition)（卫生部十一五规划教材）Chief editor Lin Yuan, Li Shengnan 吉林科学技术出版社 2008 年 10 月，ISBN 978-7-5384-2998-5. Reference Books Textbook of Pharmacology 吉林科学技术出版社; 第 1 版 SBN: 7538429980 Journals 1. Pharmacology review, 2. Pharmacology & Therapeutics, 3. Clinical Pharmacology & Therapeutics Useful Websites 1. http://pharmrev.aspetjournals.org/content/current 2. http://www.journals.elsevier.com/pharmacology-and-therapeutics/ 3. http://www.nature.com/clpt/index.html 4. http://www.sciencedirect.com/science/journal/01637258

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Diagnostics and Electrocardiography

Credits: 6.5 Total hours: 126 Lectures hours: 78 Experiment hours 48 Grade: 3rd Semesters: 2 Yi-Min Luo , etc. Compiler: Email: [email protected]

SectionⅠ. Diagnostics Preamble： Diagnostics is a bridge course between basic medicine and clinical medicine which apply the basic medical principle, knowledge and techniques for the diagnosis of diseases. Diagnostics is the basis of the clinical medicine subjects. Diagnostics is also important for the cultivation of the clinical techniques, abilities and the professional attitudes and qualifications. This syllabus includes the basic principle, knowledge and techniques of Diagnostics and the arrangement of the teaching activities of the subject. The important contents of Diagnostics include history taking, physical examination, laboratory examination, procedure of diagnosis and medical recording. Other parts like pulmonary function test, endoscopy examination and clinical application of diagnostic techniques are for self learning. Diagnostics are related with the clinical manifestations, so the lectures of professional knowledge should be related to the clinical practice. To master the principle, knowledge and techniques of Diagnostics will facilitate the learning of other clinical subjects and medical research.

Ⅰ.Contents and Requirements Introduction Objective and requests Diagnostics is about the principle and techniques of making diagnosis. The objective of Diagnostics is to apply various examination methods to understand the disease, make the right therapy and prevention. The main contents of Diagnostics include the concepts of symptom and 226

sign. The students are required to master the principles and techniques of Diagnostics, cultivate the abilities while taking care of the patients. Contents 1. Position and role of Diagnostics in clinical medicine. 2. Diagnostics contents: The common symptoms, history taking, physical examinations, lab examination, ultrasound examinations, medical recording, clinical thinking and progress in diagnostic techniques. 3. Establish the diagnostics logic. 4. Method of learning the subject and requirement of the subject. Teaching hours: 0.5 Teaching methods: lecturing and using multimedia to introduce about progress in diagnostic techniques.

History taking Objective and requests Inquiry (taking history of the patient) is an important method of knowing the course of the disease and is the first step of making diagnosis. So the importance of history taking should be explained and emphasized. The component and method of history taking should be mastered. Contents Important points： 1. Method of history taking and precautions. 2. Key points of history taking of every system: respirator, cardiovascular, gastrointestinal, genitourinary, endocrine systems and metabolic disorders General points：Significance of history taking Components: general data, chief complaint, history of present illness, past history, review of systems, personal history, family history, menstrual history and childbearing history, family history. Teaching hours: 7（lecture: 4，practice: 3） Teaching methods: lecture about history taking content and procedure.（listen to a record of history taking of some typical disease, take notes and finish a medical recording.

Symptom 227

Objective and requests Symptom is an abnormal sensation perceived by the patient. To learn the common symptoms is important for making the differential diagnosis. Students are required to be familiar with the common symptoms and master the etiology, pathogenesis and the clinical significance of the sympotoms. Contents Fever, mucocutaneous hemorrhage, headache, chest pain, abdominal pain, palpitation, dyspnea, cough, expectoration, hemoptysis, edema, cyanosis, nausea, vomiting, diarrhea, jaundice, hematemesis, hematochezia, constipation, hematuria, oliguria, polyuria, frequent micturition, urgent micturition, odynuria, vertigo, syncope, convulsion, Tics, disturbance of consciousness. Key points are marked with“★” fever： 1. definition 2. pathogeny and sort of fever： 1) infective fever； 2) noninfective fever. 3. ★onset and occurrence of fever（acute and chronic）,process and patterns of fever(continuous, remittent, intermittent and irregular fever. pain： 1. pathophysiology 2. clinical features: Region, quality, provocative and palliative factors and associated symptoms. 3. the characteristics of common clinical pains (1.headache 2.chest pain 3.abdominal pain 4. joint pain 5.backache） palpitation： 1. pathophysiology； 2. etiology and clinical feature； 3. associated symptoms； digestive hemorrhage： hematemesis:1.etiology 2.differential diagnosis between hematemesis and hemoptysis 3.differential diagnosis between ulcer bleeding and esophageal varices bleeding. hematochezia: characteristics of clinical significance。（ 1.fresh blood stool 2.tarry stool） jaundice： 228

1. general description of jaundice： 2. ★differential diagnosis between hemolytic, obstructive and hepatocelluar jaundice. Symptoms of respiratory system： 1. cough and expectoration（1.pathogenesis；2. Etiology and clinical features；3.associated symptoms and key points in history taking） 2. hemoptysis（a.definition and pathogenesis of hemoptysis, differential diagnosis between hemoptysis and hematemesis. b. clinical features of hemoptysis；c. associated symptoms and history taking of hemoptysis. 3. ★dyspnea a.Etiology, pathogenesis and clinical features：（ 1.★pulmonary（Expiratory, inspiratory, mixed 2. ★ carcinogenic （ left or right heart dysfunction ）； 3.toxic 4.Neuropsychiatric 5.hematogenous） b.associated symptoms and history taking of dyspnea. ★cyanosis： 1. pathogenesis 2. clinical features and classifications: ★edema: 1. pathogenesis 2. Etiology and clinical features 3. differential diagnosis between edema of cardiac renal origin nausea vomiting: 1. Etiology, pathogenesis 2. clinical features diarrhea: 1. Etiology and pathogenesis； 2. clinical features constipation : 1. Pathogenesis 2. Etiology and classification ★disturbance of consciousness： Etiology, pathogenesis and clinical features of disturbance of consciousness mucocutaneous hemorrhage： pathogenesis and clinical features 229

★hematuria, oliguria, anuria： definition, etiology and clinical features. frequent micturition, urgent micturition, odynuria： etiology and clinical significance. syncope: Etiology and clinical features convulsion and tic： Etiology and clinical features vertigo： Etiology, pathogenesis and clinical features Teaching hours: 7.5 Teaching methods: Lecture about the key points, other parts are learned in practice class or by oneself.

Physical examination The basic examination methods and examination of general appearance Objective and requests: 1. Master the procedure and content of the physical examination 2. Master the normal examination results and the clinical significance of the abnormal results 3. Master the general examination content, the clinical significance of normal result and the abnormal signs. Contents 1. Key points: a) The basic methods of inspection, palpation, percussion, auscultation and olfactory examination. b) The clinical application of deep palpation. c) The clinical features of 5 percussion sounds. 2. Important points: d) The contents of general appearance examination. e) The clinical significance of the typical signs. f) The relationship of gender and age with disease. g) Temperature （method of taking temperature, range of normal temperature and 230

variation） h) breathing（see pulmonary examination）、 i) pulse and blood pressure（see the vessel examination）， j) the clinical significance of the above 4 examinations k) development and nutrition， l) Consciousness disorder m) facial features and expressions ,position and gaits n) Identification and clinical significance of elasticity, coloration, eruption, hemorrhage, spider angioma and edema of the skin. o) Examination of the lymph nodes

3. General point: p) Understand the importance of systematic PE. q) Distribution of the lymph nodes and the clinical significance of changes.

Teaching hours: 6 Teaching method: 1. After lecture, one student will be selected as simulated patient for demonstrating of methods of inspection, palpation, percussion, auscultation examination. 2. Demonstration and explanation of abnormal signs using ppt and video. 3. Emphasis put on the contents of examination and the clinical significance. Procedure and signs are learned in practice classes.

Head and neck Objective and requests Master the examination order and methods, to identify the clinical significance of normal and abnormal signs. Contents: 1. Key points: 1) Examination method and clinical significance of oral mucosa membrane, tonsil, thyroid gland, trachea position, carotid artery pulsation and jugular vein distention. 2) The clinical significance of the examination of pupils. 231

2. Important points: 1) Master the examination order and methods of head and neck. 2) to identify the clinical significance of normal and abnormal signs 3. General point: 1) Examination order and methods of eye, ear, nose. Examination and of lip, teeth, gum, tongue, pharynx and the clinical significance of the signs. 2) The motion and shape examination of neck. The clinical significance of the normal and abnormal signs. Teaching hours: 2 Teaching methods: Emphasis put on the contents of examination and the clinical significance 3 practice classes for the above basic examination methods, examination of general appearance and examination of head and neck

Thorax and lung Objective and requests: 1. Master the application of inspection, palpation, percussion, auscultation in examination of Chest and lung. 2. To identify the surface landmarks of the chest. 3. To master the clinical significance of the abnormal signs of the chest and lung. Contents: Key points are marked with“★”. 1. Imppoints： vocal resonance： The examination methods and clinical significance of vocal resonance. The mechanism, characteristics and clinical significance of friction fremitus. The main symptoms and signs of respiratory diseases: lobar pneumonia, chronic bronchitis, asthma, pleural effusion, pheumothorax. The normal morphology of the thorax and thoracic deformity. 2. General points： to identify the surface landmarks of the chest. Chest wall, thorax and breast. a) superficial landmarks of the chest:（1. bony landmarks；2. vertical lines；3.natural fossae and anatomy regions；4.the boundary of lung and pleura） b) Chest wall, thorax and breast（1.examination of chest wall；2.inspection, palpation of the 232

breast and signs of common diseases of breast）. c) ★lung and pleura： 1.★inspection：changes of respiration movement、rate、pattern and their clinical significance; 2.★palpation： examination procedure of thoracic expansion, vocal fremitus, pleural friction; 3.★percussion ： techniques and precautions of percussion, direct percussion. Abnormal percussion notes: tympany, hyperresonnance, resonance, dullness, flatness. Percussion method and clinical significance of lung border, lower border and range of mobility. Normal and abnormal percussionsounds; 4.★auscultation：a.★normal breath sound（features and distribution of vesicular breath sound, bronchial breath sound, bronchovesicular breath sound, b.★abnormal breath sounds and their clinical significance c. ★crackles, rales：mechanisms, classifications, features and clinical significance. moist crackles：coarse, medium, fine, crepitus. wheezes crackles：sibilant and sonorous, d.vocal resonance：The examination methods and clinical significance of vocal resonance. e.The mechanism, characteristics and clinical significance of friction fremitus, f.The main symptoms and signs of respiratory diseases: lobar pneumonia, chronic bronchitis, asthma, pleural effusion, pheumothorax. Teaching hours: 12（lecture:6, practice: 6） Teaching methods: lecture about the key points and the important points. Examination methods and abnormal signs will be learned in practice class.

Heart and vessel Objective and requests 1. Master the features of the first heart sound and the second heart sound, the differential diagnosis and the clinical significance when increased or decreased. 2. Master the measurement of blood pressure the clinical significance of abnormal blood pressure. Master the pathogenesis and clinical significance of murmurs. 3. Master the percussion of the border of heart dullness and the auscultation of the heart murmurs. Master the identification of the systolic and diastolic murmurs. Master the features of the common arrhythmia (tachycardia, bradycardia, premature beats and atrial fibrillation). Master the examination of pulse and the pathological vascular signs. 4. Master the symptoms and signs of common heart disease: heart failure and chronic rheumatic 233

heart disease. Contents: Key points are marked with“★”. 1. Imp points: shape of precordial region; position, strength, range and rhythm of apical impulse and the clinical significance of changes; percussion of the heart border and the influence of the thoracic and abdominal disease on the heart border; heart rate and rhythm; auscultation of the first heart sound and the second heart sound, extra heart sound, murmur. 2. General points： precordial region and the clinical significance of other precordial pulsation; pathogenesis, features and the clinical significance of pericardial friction rub; the differential diagnosis with the pleural friction rubs. Artery pulsation, pulse rate and rhythm. heart： a) inspection: 1.shape of precordial region; 2.★apical impulse: position, strength, range and rhythm of apical impulse and the clinical significance of changes. 3．The clinical significance of other precordial pulsation. b) Palpation: 1.position, strength, range and rhythm of apical impulse and the clinical significance of changes; 2.★ causes, position, timing (systolic or diastolic? Continuous or discontinuous?) and clinical significance of precordial thrill. c) Percussion:1.percussion method; 2.★normal border of heart dullness; pathogenesis, features and the clinical significance of dullness change; 3.constituent of heart border and the influence of the thoracic and abdominal disease on the heart border. d) Auscultation:1.★auscultatory valve areas; 2.★physiology of normal heart sounds, differential diagnosis between the first heart sound and the second heart sound; 3.★heart rate and cardiac rhythm; 4.★changes of heart sound：a. the first heart sound: strength, features, causes of change and clinical significance of changes. b. causes and clinical significance of accentuated, diminished and split 2nd heart sound in aortic valve and pulmonary valves area; 5.★ pathogenesis, features and clinical significance of gallop rhythm, opening snap and click; 6.★cardiac murmurs: a. pathogenesis of cardiac murmurs; b. murmur analysis: position, features, timing (systolic or diastolic? Continuous or discontinuous?), degree (grading of systolic murmur) and conduction; 7.pathogenesis, features and the clinical significance of pericardial friction rub; the differential diagnosis with the pleural friction rubs. 234

blood vessel: 1.Artery pulsation, pulse rate and rhythm; 2.degree of pulsation, condition of vessel tension and vessel wall; 3.★water hammer pulse and paradoxical pulse; 4.★capillary pulsation; 5.★ capillary murmur and pistol shot of big arteries; 6. ★the measurement of artery blood pressure the clinical significance of BP. Teaching hours: 19（lecture:10, practice: 6）. Another 3 hours are added for the abnormal signs of heart and lung. Teaching methods: lecture about the key points and the important points. Examination methods and abnormal signs will be learned in practice class.

Abdomen Objective and requests 1. Mater the examination methods of abdomen (esp. liver and spleen palpation). 2. Be familiar with the common signs and their clinical significance. 3. Understand the superficial anatomy and the sub region of abdomen. Contents: Key points are marked with“★”. 1. Important points： Respiration movement, peristalsis, skin, percussion of liver and spleen and tenderness in renal region. 2. General points： Superficial anatomy and the sub region of abdomen. 1) Superficial anatomy and the sub region of abdomen. 2) abdominal examination： A. inspection：(1. ★shape; 2. Respiration; 3.★ venous distention of abdomen; 4. Peristalsis; 5.skin ) B. palpation；(1. ★palpation method；2.★contents: Muscle tension, tenderness, rebound tenderness, mass, palpation of liver, spleen, kidney and gallbladder. C. percussion：(1.percussion of liver and spleen and tenderness in renal region. 2.★shifting dullness and fluctuation) D. auscultation：(1.★borhorygmus；2.gurgling；3.vessal bruits) E. ★symptoms and signs of common disease of abdomen: Peptic ulcer, portal 235

hypertension, peritonitis. Teaching hours: 10（lecture: 4，practice: 6） Teaching methods: Lecture about the key points and the important points. Examination methods and abnormal signs will be learned in practice class.

Anus, rectum, genitalia, extremities Objective and requests 1. Master the examination of spine and extremities and the clinical significance of pathological changes. 2. Method and importance of Anus and rectum examination. Contents: 1. method of anus, rectum and genitalia examination 2. spine：curvature, deformity, tenderness and sensitivity with percussion, mobility. 3. Extremities: appearance, range of motion, joints swelling and stiffness, venous distension of lower extremities. Teaching hours: 2 Teaching methods: Lecture about the key points and the important points. Learn the Examination methods of spine and extremities.

Neurological system Objective and requests 1. To master the examination methods and clinical significance of the reflexes. Key points are marked with“★” 2. Be familiar with neurological examination contents and methods (sensory function, motor and vegetative nerve function). Contents: 1. Lecture about significance of examination of sensory function, motor and vegetative nerve function. About the examination methods, Learn by himself. 2. ★examination methods and clinical significance of the pathological reflexes 1. superficial 236

reflexes：abdominal reflex, cremasteric reflex; 2. deep reflexes：biceps reflex, triceps reflex, brachioradialis reflex, knee reflex and ankle reflex; 3 pathologic reflexes: a. （1）Babinski sign and Oppenheim sign, Gordon sign; （2）Hoffmann sign; b. meningeal irritation signs：（1）nuchal rigidity;（2）Kernig sign;（3）Brudzinski sign. Teaching hours: 9（lecture: 6, practice: 3） Teaching methods: Lecture about the key points and the important points. Examination methods and abnormal signs will be learned in practice class.

Pulmonary function test and blood gas analysis Objective and requests 1. Master the clinical significance of lung volume and ventilator function test and the clinical application of pulmonary function test. Key points are marked with“★” 2. Be familiar with gas exchange function test and the small airway function test. Understand the Pulmonary function test items and changes of obstructive and restrictive ventilation dysfunction. 3. Learn the blood gas analysis and acidbase balance. Understand the common respiratory failure and acidbase imbalances to assist the diagnosis. Contents 1. ★the clinical significance of lung volume and ventilator function test. 2. the clinical application of Pulmonary function test（1.★ventilator function test 2. gas exchange function test.） 3. Be familiar with the parameters of Pa2, PaCO2 , CaO2, SaO2, BE,BB,SB. 4. Know the normal value and the clinical significance of the parameters. 5. Feature of the common respiratory failure and acidbase imbalances. Teaching hours: 2 Teaching methods: 1. Emphasis put on the principle and the clinical application of pulmonary function test. Explain the pulmonary function changes with examples common pulmonary disease. 2. Explain the metabolic acidosis, respiratory acidosis, respiratory alkalosis with clinical case as examples. 237

Diagnosis steps, thinking method and medical record writing Objectives and Requirements 1. To make the students understand that the medical s is of important significance for clinical diagnosis and therapy, teaching, research and legal basis.Students must be serious about the medical record writing and seek truth from facts, be able to write a fluent, clear record with correct format according to the real situations and conditions.Understand the diagnosis steps and gradually master the process of thinking. 2. Combined with clinical practice, to training the students’ ability of diagnosis analysis, to familiarize students with the dialectical relation of symptoms and signs, appearance and essence, generality and individuality, part and whole, primary and secondary contradiction, morphology and function.

Contents

1. ★Diagnostic procedures and ways of thinking 1) Data collection, arrangement and analysis 2) ★Diagnosis contents 2. Medical record writing 1) The importance of medical records 2) Notes to Medical record writing 3) The format and items of in-patient medical record

Teaching hours

7 hours（lecture 4 hours, practice 3 hours）

Teaching method

Teachers will explain the key content, cases or television teaching material will be used to give the analysis, synthesize and demonstration. About the clinical practice and case writing, on the basis of familiar with the inquiry students will be led to the ward to do history collection and physical examination, the teacher introduces relevant laboratory examination and students are required to complete a whole case. 1. The teacher lead students (5-8 students per group) to the ward ,students will make the medical history and physical examination under the teacher’s direct. 2. The teacher will introduce the format and the complete contents of a medical record (Including the process and discharge records )

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3. Students gather a complete medical history 4. Teachers modify the medical records been written by students, point out the deficiencies and meaning of the modification in the next practice class.

Table 1.Hours distribution Content Lecture Practice Total Introduction 0.5 0.5 Common symptoms 7.5 7.5 Inquiry 4 3 7 Basic examination method 2

General state examination 4 3 11 Examination of head and neck 2 Lung check 6 6 12 Heart Examination 10 9 19 Abdomen inspection 4 6 10 Anus, rectum, spine and limbs inspection 2 2 Neurological system inspection 6 3 7 Pulmonary function test and blood gas analysis 2 2 Diagnostic procedures and thinking method 2 2 clinical practice and medical record writing 2 3 5 Total 54 33 87

Laboratory Diagnosis Blood routine examination

Objectives and Requirements

To master red blood cell count , hemoglobin determination, reference value of the WBC and leucocyte differential count and the clinical meaning of its’ change.

To be familiar with morphological classification of Anemia, reference value and clinical meaning of hematocrit and the average index of RBC ,measurement of reticulocyte count and erythrocyte sedimentation rate, 239

to master these reference value and clinical meaning.

To understand all the methods of the above test .

Contents 1. red blood cell count and hemoglobin determination 1) measurement and reference value of red blood cell and hemoglobin 2) ★physiological changes of RBC and Hb, and the clinical significance of the pathologic increase or decrease(focus on the pathologic decrease ) 3) ★Pathological morphology change of RBC (changes of RBC size, morphology and bloodthirsty), the clinical significance of nuclear residue and Nucleated Red Blood Cells. 2. White blood cell count and differential count 1) Sketch cyto-dynamics of all kinds of leukocyte. 2) ★reference value and physiological changes of the WBC and leucocyte differential count 3) ★the clinical significance of each kind of leukocytosis and leukopenia 4) ★the clinical significance of nuclear shift 5) Leukocyte common pathological morphology and its clinical significance. 6) ★Concept and clinical significance of leukemoid reaction. 3. Method, reference value and clinical significance of HCT and RBC average index calculation. 4. Morphological classification of anemia: macrocytic anemia, normocytic anemia, microcytic hypochromic anemia, microcytic anemia. 5. ★Reticulocyte count: dyeing principle, method, reference value and clinical significance. 6. Introduction the principles of hemolytic anemia laboratory 7. The erythrocyte sedimentation rete (ESR) measurement 1) ★Principles and methods of the erythrocyte sedimentation rete (ESR) measurement, influence factors of ESR. 2) ★Reference value of ESR and the clinical significance of increasing fast.

Teaching Hours: 7 hours（lecture 4 hours, practice 3 hours）

Teaching method: Combination of lectures and experiment

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1. Guide the student to learn the method of analysis, according to the actual need and from the overall situation to apply the test and analyze the test results. 2. In the experiment class, first teacher will introduce the instrument and give a demonstration of the red blood cell count , hemoglobin determination, the WBC count, leucocyte differential count, Reticulocyte count and ESR measurement, then the students will do the experiments by themselves. 3. Microscope demonstration: leukocyte differential count

Bone Marrow Examination Objectives and Requirements 1. To master the indications, contraindications and clinical significance of bone marrow cytology 2. To understand the normal bone marrow cells form and classification results, bone marrow cell morphological characteristics of common blood diseases. Contents 1. The clinical significance, indications and contraindications of bone marrow cytology. 2. the general rule of morphological evolution of white blood cells mature process. 3. The normal form of red blood cells, granulocyte, lymphocytes, monocytes, megakaryocyte, plasma cells, reticulocyte. 4. ★Normal bone marrow and commonly used cytochemical stain. 5. To understand the bone marrow features of acute leukemia , chronic leukemia and aplastic anemia. Teaching Hours: 5 hours（lecture 2 hours, practice 3 hours） Teaching method: 1. Make a wall chart in cell morphology teaching 2. Microscope or aids (slide, TV video) 1) Normal bone marrow cells(nuEP, myelocytes, megakaryocyte, plasma cells, etc. ) 2) Demonstration of commonly used cytochemical stain.

Feces and urine routine inspection Objectives and Requirements To master the urine test method and clinical significance. 241

To be familiar with stool examination and the clinical significance of abnormal changes, Methods and clinical significance of occult stool blood test. Contents Urine examination 1. Urine specimen collection and preservation 2. ★Urine inspection contents and research significance 1) The general character: Urine output, appearance, smell, acid-base reaction, specific gravity. 2) chemical examination: Protein, sugar, ketone body.

3) Microexamination: RBC, WBC, epithelial cells, urinary cast and crystalline.

Stool examination Specimen collection: 1) Stool specimen collection and preservation, 2) Stool test method and clinical significance,

a) General character check: Color, character, odour and macroscopic appearance.

b) Microexamination: Cells, parasitic ovum, protozoon, fat granule and food residue, etc.

c) ★facal occult blood text (FOBT): Methods and clinical significance. Teaching Hours: 6 hours（lecture 3 hours, practice 3 hours） Teaching method: 1. Teacher will lay stress on lecturing normal results and clinical significance of urine routine inspection. 2. To observe abnormal urine specimens and microscopy urine sediment. 3. Teacher will lay stress on stool test methods and its’ clinical significance. 4. To demonstrate the specimen or using television video to teach： 1) The feces abnormal appearance， 2) Red and white cells, macrophages, food residue and parasitic ovum. 3) Facal occult blood text, FOBT

Nephric Function Examintion Objectives and Requirements To understand common renal function test methods ( test of the renal clear function, glomerular

242

filtration function and renal tubular function) and master its clinical significance Contents: Kidney function tests

1. ★Common renal function test and its clinical significance: 1) ★endogenous creatintne clearance rate. 2) ★Serum urea nitrogen and creatinine measurement. 3) ★Concentration dilution test. 4) Uosm. 5) Osmotic solute clearance measurement. 6) Free water clearance measurement. 2. ★The choice and application principle of renal function test. Teaching hours:3 hours Teaching method: To guide students contact theory, combined with the characteristics of the renal inspection to make a reasonable choice.

Liver Function Test Objectives and Requirements 1. To master the clinical significance and selection principle of common liver function test. 2. To master the clinical significance of common serum enzyme check 3. To master the clinical significance of viral hepatitis check. Contents 1. ★Protein metabolism function test: Assays for Total Serum Protein, Albumin and globulin ratio, serum protein electrophoresis, alpha fetoprotein. 2. ★ Bilirubin metabolism function testing: Serum bilirubin quantitative determination, urobilirubin and urobilinogen inspection. 3. ★Serum enzymology check: determine of serum transaminase, alkaline phosphatase, γ 一 GT, monoamine oxidase. 4. Dye discharge function testing: Indigo cyanide green retention test. 5. ★Viral hepatitis markers inspection. 6. ★Liver function test selection principle Teaching hours: 5 hours Teaching method:

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Focusing on common liver function test and liver function test selection principle. Introduce liver function test change of common liver disease.

Thrombosis and hemostatic disorder inspection Objectives and Requirements 1. To master the inspection principle and clinical significance of hemostatic and coagulopathy common test . 2. To understand the causes of hemostatic disorder and coagulopathy and common principle and method of inspection 3. To understand the hemorrhagic disease test selection principle according to the particularity of contradiction. Contents 1. ★Principle, reference value and clinical significance of common laboratory inspection for hemostatic disorder and coagulopathy (blood platelet count, bleeding time, clotting time, plasma prothrombin time, activated partial thromboplastin time, etc.) 2. Common cause of hemostatic disorder and coagulopathy. ★Laboratory selection principle and laboratory diagnosis steps of hemorrhagic disease. 3. Normal hemostasis and clotting mechanism. laboratory inspection principle, reference value and clinical significance of anticoagulation material and fibrinolysis.

Teaching hours 7 hours（lecture 4 hours, practice 3 hours） Teaching method 1. Lectures hemostatic disorder and coagulopathy mechanism, causes for hemostatic disorder and coagulopathy and the relationship with other laboratory tests. 2. To determine blood platelet count, bleeding time and clotting time. 3. Demonstration: capillary fragility test, prothrombin time, vascular withdrawal test. (With the use of television teaching material)

Coelomic fluid inspection Objectives and Requirements 1. To master the clinical significance of cerebrospinal fluid examination, serous cavity effusion

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classification and occurrence mechanism, transudate and percolate identified points. 2. To be familiar with cerebrospinal fluid characteristics of common brain and meningeal disease. 3. To understand the indications, inspection method, reference value and clinical significance of semen and prostatic fluid test. Content Cerebrospinal fluid (CSF) examination: 1. ★the indications and specimen collection of cerebrospinal fluid examination. 2. ★Inspection content: 1) General character check: color, transparency and concretion 2) chemical examination: Protein qualitative and quantitative, sugar quantitative and c hloride quantitative. 3) Microexamination: The cell count and classification. 4) Bacteriology inspection 5) Common brain and meningeal disease cerebrospinal fluid characteristics.

Serous membrane fluid examine: 1. Inspection content:

1) General character check: Quantity, color, transparency, solidification degree, specific gravity, etc

2) Chemical examination: Mucin qualitative test, protein quantitative.

3) Microexamination: Cell count, cell classification, tumor cell inspection. 2. Transudate and exudate identify points, the characteristics of common transudate.

Semen and prostatic fluid inspection (Self-learning): 1. Semen and prostatic fluid inspection indications, the specimen collection and inspection 2. Semen test content

1) General character check: Quantity, color, transparency, consistency, liquefying time and pH.

2) Microexamination: inspection of sperm count, activity ratio, motility, morphology and cytology. 3. Prostate fluid test content:

1) General character check: Color, transparency, character.

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2) Microexamination: Lecithin, blood cells and epithelial cells, prostate granular cell amyloid body, sperm, trichomonad, and tumor cells, etc.

Teaching hours: 2 hours Teaching method

1. Teaching will focusing on the examine methods and clinical significance of cerebrospinal fluid and serous membrane fluid.

2. To observe the normal and abnormal cerebrospinal fluid general characters and features.

3. To do the cerebrospinal fluid and serous membrane fluid examine.

Clinical common biochemistry tests Objectives and Requirements To understand

1. Blood sugar and its metabolites detection and the clinical significance.

2. Serum lipid and lipoprotein detection and the clinical significance.

3. Myocardial enzyme and myocardial protein detection and the clinical significance.

4. Serum electrolyte detection.

5. Serum iron and its metabolites detection.

Self-learning Other serum enzyme detection, endocrine hormone detection, therapeutic drug monitoring, pathogen check.

Contents

1. ★Blood sugar and its metabolites detection and the clinical significance. Serum lipid and lipoprotein detection and the clinical significance.

2. Myocardial enzyme and myocardial protein detection and the clinical significance.

3. Serum electrolyte detection.

4. Serum iron and its metabolites detection.

5. Other serum enzyme detection.

6. Endocrine hormone detection, Therapeutic drug monitoring.

The rest of the content for self-study.

Teaching hours: 2 hours 246

Teaching method: lectures

Clinical common immunology test Objectives and Requirements 1. To be familiar with the clinical significance of serum immune protein detection. 2. To master common tumor markers detection. 3. To understand the clinical significance of auto-antibody determination. Contents

1. Detection and clinical significance of immune globulin G, immune globulin A. 2. ★tumor marker: detection and clinical significance of AFP, carcino-embryonic antigen. 3. Detection and clinical significance of cancer antigen-50, cancer antigen-125 and cancer antigen-199. 4. Clinical significance of auto-antibody determination. (rheumatoid factors, antinuclear antibodies) The rest of the content for self-study. Teaching hours: 2 hours Teaching method: lectures

Case Discussion

Teaching Hours: 3 hours (internship)

Teaching method: a complete cases discussion guides by teachers.

Table 2.Hours distribution Content Lecture Practice Total blood routine examination 4 3 7 Bone marrow cytomorphologic examination 2 3 5 Feces and urine routine inspection 3 3 6 nephric function examintion 3 3 liver function test 5 8 Thrombosis and hemostatic disorder inspection 4 3 7 Coelomic fluid inspection 2 5

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Clinical common biochemistry tests 2 3 Clinical common immunology test 1 Case Discussion 3 3 Total 26 15 45 Note: Slightly change may be given according to each chapter content and other condition.

Ⅲ. Ability Training Requirements 1. Clinical communication ability training: Through this subject students must learn how to communicate with patients, to obtain the patient's trust and cooperation, learn clinical communication. 2. Clinical skills training: To master physical examination methods and skills. 3. Clinical thinking ability training: According to the diagnostic program, students are required to make diagnosis and differential diagnosis on the basis of clinical analysis and comprehensive of the medical history, physical examination and other necessary auxiliary examinations.

Ⅳ.Internship program

Students Number Name Contents Hours Note number

the general projects of the history, 1 Inquiry complaints, present illness, past history, 3 15-20 Compulsory family history

Basic Examination method, basic methods of Inspection, palpation, 3 2 General percussion and auscultation 15-20 Compulsory

Examination, Examination of head and neck Normal thorax Chest skin marks and chest wall, thorax, 3 and lungs 3 15-20 Compulsory breast, Lung Interrogation inspection

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Normal heart and blood heart inspection, palpation, percussion 4 3 15-20 Compulsory vessel and auscultation，Vessel inspection inspection

thoracocyllosis 、 abnormal breathing 、 abnormal signs rhythm pulmonary abnormal percussion 5 of breast, lung, sound, pathological breath sounds , dry 3 15-20 Compulsory heart and wet rale,common various cardiac anomaly signs,the change of heart sounds and all kinds of noise Normal Abdominal skin mark and partition, abdomen, spine abdominal inspection, palpation, 6 3 15-20 Compulsory and limb percussion and auscultation, spine and inspection limb inspection Abdominal common abnormal signs such Normal as hepatosplenomegaly, abdominal abnormal signs varicose veins , ascites, abdominal mass, 7 3 15-20 Compulsory of abdomen, tenderness, rebound tenderness, etc. spine and limb common spinal and limbs abnormal morphology and function disorder. Normal nervous 8 system Normal nervous system inspection. 3 15-20 Compulsory inspection

General blood red cell counts 9 3 15-20 Compulsory test 1. hemoglobinometry

Leukocyte count, General blood operation of WBC classification method， 10 3 15-20 Compulsory test 2. the identification of all kinds of white blood cells 1. To understand the clinical significance of bone marrow cytology and inspection requirements 2. To understand the blood cells Bone Marrow morphological evolution during the 11 3 15-20 Compulsory Examination maturation process 3. To understand normal bone marrow cells form and classification results 4. To preliminary understand the bone marrow feature of common blood disease inspection of platelet count hemostasis and determine of bleeding time and 12 blood coagulation time 3 15-20 Compulsory coagulation tourniquet test disorder, ESR, erythrocyte sedimentation rate ， 249

etc. reticulocyte count Urinary and Urine routine test 13 fecal routine 3 15-20 Compulsory inspection stool-routine test commonly used treatment gastric juice and duodenal drainage fluid 14 technology in inspection, thoracentesis, bone marrow 3 15-20 Compulsory clinic(video puncture, lumbar puncture recording ) history-taking, systematic Acquire a complete medical history and 15 inspection, systematic physical examination, to 3 15-20 Compulsory medical record compile a complete medical record writing Medical case group discussion 16 Case discussion 3 15-20 Compulsory of each system common disease

Ⅴ.Assessment

Final mark＝attendance＋experiment mark＋final exam Attendance: 10% Experiment mark: 20%（lab report 10％，clinical skills assessment 10％） Final exam: 70%

Ⅵ.Textbooks and reference Lv Zhuoren, Lei Han. Textbook of diagnostics www.sciencep.com

SectionⅡ. Electrocardiography Ⅰ. Course Description Electrocardiography is a professional technology in the diagnosis of heart disease from ECG in medical science. ECG is an important part of diagnostics and plays an important role in the clinical diagnosis of heart disease. Medical undergraduates should have a solid basic knowledge of ECG. Ⅱ. Contents and Requirements Purpose 1. Master the clinical significance of electrocardiogram. Master the ECG coordinates and determination method. Master the name, representative significance, normal value and clinical significance of ECG wave, segment and interval. Master the calculation method of 250

heart rate. Master the common abnormal ECG characteristics and diagnostic criteria. ★ is focus on the core content . 2. Master the principle of the ECG and the common lead. To be familiar with electrical axis, the clock to the translocation and its clinical significance . Learn the proper operation of ECG. Teaching contents 1. ★Basic knowledge of ECG，including the concept, principle , common lead, determination method and clinical significance of ECG. 2. ★The normal ECG waveform characteristics and normal value. Normal sinus rhythm. 3. Electrical axis, the clock to the translocation,the concept of heart rate and its clinical significance. 4. ★The characteristics and diagnostic criteria of several common ECG 1) Atrial, ventricular hypertrophy 2) myocardial infarction 3) Common arrhythmias (sinus arrhythmia, premature contraction, ectopic tachycardia, atrial flutter and atrial fibrillation, heart block including sinoatrial block, Intra-atrial block, atrioventricular block, bundle-branch block, pre-excitation syndrome, escape and escape rhythm) Teaching hours 26 hours (teaching- 14 hours ,experiment- 12 hours) Teaching methods 1. The production of ECG, Tracing method and lead by using the teaching aids. 2. Learn and determine normal ECG and the ECG of heart hypertrophy, myocardial infarction and arrhythmia. 3. Request every student to write the report on one normal and three abnormal ECG under the teacher’s proofreading. 4. Guide the students to read ECG by using multimedia and learn the clinical significance.

Ⅲ. Training requirements 1. Clinical skill training Master the methods and techniques of ECG operation by learning. 2. Cultivate the clinical ideation of students Request every student to analyze , synthesize and make the diagnosis or differential diagnosis 251

according to medical history, physical examination and necessary auxiliary examination data. Ⅳ. ECG exercitation syllabus

Number Number Content abstract Nature Species Period Remarks of each group professional 1 Normal ECG basic 3 15-20 master foundation Common Abnormal professional master 2 basic 3 15-20 ECG foundation Common Abnormal professional master 3 basic 3 15-20 ECG foundation Common Abnormal professional master 4 basic 3 15-20 ECG foundation

Ⅴ. Assessment

General appraisal score= Final examination performance 100% Ⅵ. Textbooks and references 1. Diagnostics The sixth edition, chief editor wenbing Chen, People Health Publishing House 2. Diagnostics The seventh edition, year medical specialty, chief editor wenbing Chen, People Health Publishing House 3. The electrocardiogram experiment chief editor xinming zhang

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Traditional Chinese Medicine

Credits: 3 Total hours: 76 Lectures hours: 52 Experiment hours 24 Grade: 3ed Semester: 2 Zhi-Gang Liu Compiler: Email: [email protected]

Preface Traditional Chinese Medicine (TCM) is an integral part of Chinese culture. Over the centuries, various activities and aspects of the practice of TCM have made tremendous contributions to the prosperity of the Chinese nation. It’s good reputation resulted from its great vitality is demonstrated by the fact that when compared with other traditional medicine its clinical application has never declined over the past several thousand years. So the overseas students who study in China should learn and be familiar with this important part of medicine. As one of the earliest discipline, TCM was founded in 1958. It is the second-level base for awarding master degree. The division includes department of Traditional Chinese Medicine, and the department of TCM, Acupuncture, and Spinal Orthopaedic. The faculty of this division enjoys rich experience in treating diseases by traditional Chinese medicines (TCM), such as diseases with Yang deficiency syndrome, insomnia, sub-health, cardiovascular, cerebrovascular diseases, renal diseases, diabetes, neoplasia, gynaecopathia, and senile diseases, etc. Meanwhile, taking the advantage of the effectiveness of TCM in treating some difficult diseases, we cooperate with other medical disciplines and have gradually formed the characteristic of integrating TCM with western medicines as well as medicine treatment with food together. Our work not only involves the clinic and research, but tutorage as well. Particularly, we have taught overseas students for many years. The faculty includes one professor (Chief Physician), four associate professors (Associate Chief Physician[s]), six lecturers (Attending Physician[s]) and five teaching assistants (Resident 253

Physician[s]). Among them, four have doctorate degrees, seven have master degrees, and three are supervisors of master students. Meanwhile, two of us are vice director’s members, and three are standing members of JiangSu Association of the Integration of Traditional and Western medicine and JiangSu Association of the Traditional Chinese medicine. Up till now, the faculty has been responsible for, or participated in more than 10 research programs at various levels and published more than 40 academic articles as well as compiled over 10 books. There are altogether 20 postgraduates who have graduated specializing in TCM. Convenient to students’ studying the course, the main contents of the curriculum are arbitrarily divided into three kinds: “master”, “be familiar with” and “understand” which expect different approaches from students. 1. The “Master”- contents are the most essential and the most important contents, and students must be able to precisely memorize this category of contents and correctly paraphrase them. 2. The “be familiar with”- contents are the main contents, and students must know this second kind of contents. 3. The “understand”-contents belong to the general/common contents, and students only need to recognize and comprehend them.

Ⅰ. Preamble and Objectives 1. Students should be familiar with basic conceptions of TCM, understand methods of diagnosis and syndrome differentiation. They also should be familiar with herbals and formulas which are often used in clinical settings. 2. Students should be familiar with the processes of acupuncture and spinal orthopedic treatment.

Ⅱ.Contents and Requirements Chapter 1. Preface To be familiar with To be familiar with the differences between TCM and western medicine. To understand To understand the theoretical structure and characteristics of TCM.

Chapter 2. Basic Theory of TCM To master 254

1. To master the basic concepts of the theory of Yin–Yang and its main contents. 2. To master the basic concepts of the theory of the Five Elements, and its main contents. 3. To master the basic concepts and contents of holism in CM and of treatment based on symptom analysis. 4. To master the basic concepts of Zang–fu viscera and the classification of the internal organs; 5. To master the main physiological functions of the Zang organs and the significances of Qi, blood, Yin and Yang in each Zang organ; 6. To master the main physiological functions of the fu viscera; 7. To master the physiological functions of the brain and the uterus; 8. To master the relationships among the zang viscera, between zang and fu viscera, and among the fu viscera; 9. To master the basic concept, the formation, the circulation, the actions and the classification of Qi; 10. To master the concept, the formation, the distribution and the excretion of body fluids; 11. To master the methodology for studying etiology in CM; 12. To master the characteristics of the six climatic pathogenic evils, the external evils, and the pestilential evils; 13. To master the concepts of Phlegm, Rheum, and blood stasis, and their causes; 14. To master the basic pathogenesis of illnesses; 15. To master the rise and fall of evil Qi and genuine Qi, and the progression and outcome of illnesses; 16. To master the basic concept of imbalance of Yin–Yang, and the basic pathological mechanisms of relative excess, relative deficiency, mutual injury, mutual repellency, mutual transformation and depletion of Yin and Yang; 17. To master the basic pathological mechanisms of Qi deficiency and disturbance of Qi activity; 18. To master the basic pathological mechanisms of blood deficiency, blood stasis, overheating of blood and hemorrhage, as well as disharmony in Qi-blood interaction; 19. To master the basic pathological mechanisms of insufficiency of body fluids, and disturbances in the distribution and excretion of fluids; 20. To master the main contents of the principles of treatment; 21. To be familiar with the application of the theories of Yin–Yang and of Five Elements in CM; 22. To understand the theoretical structure and characteristics of TCM; 255

To be familiar with 1. To be familiar with the basic concepts and main contents of the view of life and the view of illness in CM; 2. To be familiar with the basic methods of inquiry in CM and the features of diagnostics; 3. To be familiar with basic principles of health preservation of CM; 4. To be familiar with the relationships among Qi, blood and body fluid; 5. To be familiar with the basic concept, the mechanism and the movement patterns of Qi transformation; 6. To be familiar with the basic concepts of the formation, the circulation and the functions of blood; 7. To be familiar with the pathological effects of the seven passions, imbalance between work and rest, and inappropriate diet; 8. To be familiar with the basic methods of CM diagnosis; 9. To be familiar with the principles of CM diagnosis; 10. To be familiar with the fundamentals of CM diagnosis; 11. To be familiar with the principles of CM diagnosis; 12. To be familiar with the main contents of each method of diagnosis and its clinical significance; 13. To be familiar with diagnosis by means of the Eight Fundamentals; 14. To be familiar with diagnosis according to the state of Qi and blood and their interrelationship; 15. To be familiar with diagnosis according to pathological changes of the viscera and their interrelationship; 16. To be familiar with the principles of diagnosis of febrile illnesses in accordance with the six Meridians; 17. To be familiar with the principles of diagnosis and analysis of the warm illnesses by the Four Phases – Defensive, Qi, Nutritive and Blood; 18. To be familiar with the principles of diagnosis and analysis of the warm illnesses by the Sanjiao. 19. To be familiar with the main treatment methods. 20. To be familiar with the principles of health preservation in CM; To understand 1. To understand the differences between TCM and western medicine. 2. To understand broadly the formation and development of the theoretical system of TCM. 256

3. To understand the unity of Qi and its properties. 4. To understand the formation of the visceral manifestation theory and how it lays the foundation for clinical practice; 5. To understand the similarities and differences between the basic concepts of zang–fu viscera in Chinese and Western medicine; 6. To understand the relationships between the zang viscera and the body constituents, openings, fluids, and emotions; 7. To understand the pericardium and the Vital Gate in general 8. To understand the actions of genuine Qi, thoracic Qi, nutritive Qi and defensive Qi; 9. To understand the concept of endogenous pathogenic evils and their mechanisms and characteristics; 10. To understand the pathological characteristics of traumatic injuries, burns and scalds, frostbite, and bites by insects and beasts. 11. To understand relevant factors that affect the occurrence of illnesses; 12. To understand the methods of health preservation.

Chapter 3. Herbals and Formulas To be familiar with 1. To be familiar with the modification, characteristics and properties of each formula; 2. To be familiar with the 18 basic categories of herbs; 3. To be familiar with the essential information on the properties, meridian affinity, actions and indications, dosages and cautions and contraindications in the use of each herb. 4. To be familiar with the basic organizing principles for the construction of formulas of complex herbal prescriptions; 5. To be familiar with the composition, actions, and indications of each commonly used formula; To understand 1. To understand the basic properties of herbs and the principles of their clinical application; 2. To understand the clinical significance of the four natures and the five flavors; 3. To understand the concepts of lifting and lowering, floating and sinking, and meridian affinity, as well as their clinical significance and the factors that affect these properties; 4. To understand the relationship between the nature and flavor of herbs and their ability to lift, lower, float or sink; 257

5. To understand the concept of toxicity and its clinical significance; 6. To understand the principles of herb interaction, including its “seven facets,” and the principles of complementation; 7. To understand the precautions and contraindications when prescribing herbs, especially in pregnancy; 8. To understand the basic principles governing dosage and the decoction of herbs. 9. To understand the importance, motivation and consequences of modifying either the composition or the relative amounts of ingredients of a formula. 10. To understand the clinical usage of each formula.

Chapter 4. Acupuncture To master 1. To master the concept of meridians and know the meaning of meridians and collaterals and the differences between them. 2. To master the name, the distribution characteristics on the surface of the body, running direction, circulation and convergent principle of the twelve meridians and the association of the twelve meridians with the viscera. 3. To master the concept of acupoint, the classification of acupoints, and the concepts of meridian acupoints, extraordinary acupoints and ashi points. 4. To master the methods for locating acupoints and the concepts of bone-length measurements, anatomical landmarks, finger measurements, and the concepts of the three kinds of finger measurement. 5. To master the structure of filiform needle and the method of it. 6. To master the signs and the importance of arrival of Qi during acupuncture manipulations. 7. To master the concept of the fourteen meridians. To be familiar with 1. To be familiar with the external and internal relationship of the twelve meridians. 2. To be familiar with the meridian system and according to the system, try to understand that it is meridians that link the body into an organic whole. Then set up the idea that the existence of meridians is objective and try to understand the meridians in TCM the objective way. 3. To be familiar with the functions of meridians and collaterals and the clinical application of the theory of meridians and collaterals. 258

4. To be familiar with the concept of the eight extra meridians (vessels), the distribution and functioning of them and the difference between the 8 extra meridians and the 12 regular meridians. 5. To be familiar with the relationship between viscera, meridians and acupoints, be familiar with the functions of acupoints and the differences between different types of acupoints. 6. To be familiar with needles with different shape and material, the patients’ posture during acupuncture and the functions of the manipulator’s two hands. 7. Be familiar with some cautions for acupuncture treatment and the management of possible accidents in acupuncture treatment. 8. To be familiar with the methods of moxibustion, the function and cautions of moxibustion and the indications of different moxibustion. 9. To be familiar with some other techniques in acupuncture clinic such as three-edged needles, cupping, and electro-acupuncture. 10. To be familiar with several diseases usually treated by acupuncture. For example; chronic bronchitis, bronchial asthma, chronic gastritis, stroke, peripheral facial paralysis, insomnia, cervical spondylopathy, periarthritis of shoulder, sciatica, dysmenorrhea etc. To understand 1. To understand some special acupoints, know what special acupoints refer to and understand the characters and functions of luo-connecting acupoints, the eight convergent acupoints, back-shu acupoints, and front-mu acupoints. 2. To understand the functions of acupuncture and the method for selecting acupoints.

Chapter 5. Spinal Orthopaedic To master To master the examination and diagnosis of Chinese Osteopathy; the indications and contraindications of Chinese osteopathy; the palpation and therapeutics manipulation of Chinese osteopathy. To be familiar with To be familiar with the diagnosis and treatment of cervical spondylopathy; Herniation of lumbar intervertebral disc and the disorder of the thoracic vertebra. To understand To understand the history of Chinese Osteopathic and the difference between Chinese Osteopathy 259

and western osteopathy; Spine radiology.

Ⅲ. Practice Requirements Diagnostic Methods: Students should be familiar with the methods of tongue inspection and pulse taking. Acupuncture: Students should be familiar with the distribution of the fourteen meridians, and master the location and indications of thirty meridian acupoints. To master the techniques of filiform needle, cupping, and moxibustion. Spinal Orthopaedic: Students should be familiar with the examination and diagnosis of Chinese Osteopathy; the indications and contraindications of Chinese osteopathy; the palpation and therapeutics manipulation of Chinese osteopathy.

Ⅳ. Ability Training Requirements Upon completion of this subject, students will be able to: 1. Be familiar with the thinking methods of TCM and understand the major differences between TCM and western medicine. 2. Use simple treatment methods of TCM to solve health-related problems. 3. Study TCM by themselves through the internet, books, etc if they want to.

Ⅴ. Hours Distribution Content Lecture Discuss Lab

32 12

Preface of TCM 2

Basic theory of TCM 20

Formulas and Medicinals 4

Acupuncture 18 8

Spinal Orthopaedic 8 4

260

Ⅵ.Assessment Final Test 100%

Total 100%

Ⅶ. Textbook and References Text Book Traditional Chinese Medicine. Reference Books 1. Essentials of Chinese Medicine (Springer). 2. Chinese Acupuncture and Moxibustion (publishing house of Shanghai University of Traditional Chinese Medicine). Journals The American Journal of Chinese Medicine. Useful web sites 1. http://www.tcmbasics.com/ 2. http://www.tcmpage.com/ 3. http://nccam.nih.gov/health/whatiscam/chinesemed.htm

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Medical Imaging

Credits: 3.5 Total hours: 64 Lectures hours: 48 Experiment hours 16 Grade: 4th Semester: 1 Gao-Jun Teng Gang Deng Sheng-Hong Ju Ji-Yang Jin Wan-Hua Liu Compilers: Ming Yang Qin Lu Qiu-Zhen Xu, etc. Email: [email protected]

Preface Medical imaging has become central to many aspects of patient management and is ever increasing in importance. With the widespread availability of the various imaging techniques, including digital radiography (DR), ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), digital substraction angiography (DSA) , there are often several ways of investigating the same condition. Nowadays, medical imaging consists of diagnostic imaging, interventional radiology, information radiology, etc. It is important, however, to understand not only the advantages but also the limitations of modern medical imaging. We try to meet the needs of the medical student in training by explaining the techniques used in diagnostic imaging and the indications for their use. All of the course devotes to helping the student understand the principles of interpretation of plain films and other imaging modalities. It is, unfortunately, beyond the scope of limitation course to describe fully the pathology responsible for the various imaging appearances. However, students should know the guidelines for sensible selection of imaging investigations.

Ⅰ. Preamble and Objectives The course has two main purposes: first, to master the basic technology and inspection method for all kinds of medical imaging modalities, and to be

262

familiar with the basic principle of the preparation work before examination, to understand the advantages and limitations of imaging modalities according to imaging principle, scientific and reasonable for patients. Second, to master the normal imaging findings and basic pathological changes of each part of the human body, to be familiar with the character imaging signs of common diseases, so as to make a diagnostic and differential diagnosis.

Ⅱ. Contents and Requirements Chapter 1. General Theory To master To master the principle of various medical imaging modalities and the preparation work before examinations. To master the advantages and limitations of various imaging modalities in the diagnosis and treatment of different system disease. To be familiar with To familiarize with medical imaging diagnostic methods and principles. To understand To understand the development, the present status and the future of medical imaging.

Chapter 2. Radiology of Respiratory System (1) To master To master the radiological signs of lung disease：Air-space filling and Spherical shadows, air containing space and cavity, Pulmonary collapse and Obstructive emphysema. To be familiar with To be familiar with the general image technology and normal X-ray and CT appearance of Respiratory System.

Chapter 3. Radiology of Respiratory System (2) To master 1. To master the X-ray and CT findings of the pleural lesions ( pleural effusion, pleural thickening, pleural tumors, pleural calcification, pneumothorax, hydropneumothorax) 2. To master the X-ray, CT and MRI findings of the normal mediastinum and some mediastinal masses (retrosternal goitre, thymomas, lymphadenopathy, neurogenic tumors ) To be familiar with 263

1. To be familiar with the X-ray, CT and MRI findings of some mediastinal masses (hiatus hernia) 2. To be familiar with the X-ray and CT findings of the pneumomediastinum, hilar enlargement, diaphragm and chest wall. To understand 1. To understand the causes of pleural effusion and lymph node enlargement. 2. To understand the image findings of aortic aneurysm.

Chapter 4. Radiology of Respiratory System (3) To master 1. To master the X-ray and CT findings of the bacterial pneumonia, lung abscess, pulmonary tuberculosis, carcinoma of the bronchus. 2. To master the mammographic signs of breast carcinoma and benign masses. To be familiar with 1. To be familiar with the X-ray and CT findings of the chronic obstructive airway disease and metastatic neoplasms. 2. To be familiar with the X-ray and CT findings of the trauma to the chest To understand To understand the image findings of viral and mycoplasma pneumonia, fungal and parasitic disease, hydatid disease, pneumonia in the immunocompromised host, sarcoidosis, diffuse interstitial pulmonary fibrosis, radiation pneumonitis, collagen vascular diseases, pneunoconiosis, cystic fibrosis, respiratory distress in the newborn, adult respiratory distress syndrome, pulmonary emboli and infarction, lymphoma

Chapter 5. Circulatory System To master 1. To master the standard plain film in evaluating heart size. 2. To master the anterior, posterior, left and right border of the heart on the plain film. 3. To master the term of CTR.-cardiothoracic ratio 4. To master the signs of left and right atrium enlargement on the plain film. 5. To master the reason that can cause pulmonary arterial hypertension 6. To master the appearances of pulmonary venous hypertension. 264

7. To master the patterns of interstitial oedema and alveolar oedema. 8. To master the reasons of aneurysm of assending and descending aorta. To be familiar with 1. To be familiar with the CT appearance of heart and great vessel. 2. To be familiar with the MRI appearance of heart and great vessel. To understand To understand the advantages and disadvantages of different imaging modalities in evaluating heart and great vessel.

Chapter 6. Digestive system (1) Plain Abdomen To master To master: Diagnosis of pneumoperitoneum, intestinal obstruction To be familiar with To be familiar with: Plain abdominal film To understand To understand: Difference between colon and small bowel obstruction

Chapter 7. Digestive system (2) Gastrointestinal Tract To master 1. To master: Basic descriptive terms, for example, filling defect, meniscus sign. 2. To master: Diagnosis of GI diseases, for example: gastric carcinoma, and differential diagnosis, for example, between benign gastric ulcer and ulcerating malignancy. To be familiar with To be familiar with: Normal alimentary tract radiography, and other GI diseases, for example, esophageal carcinoma. To understand To understand: GI imaging techniques, for example, antegrade and retrograde barium study. How to observe and analyse GI radiography.

Chapter 8. Digestive system (3) Hepatobiliary System, Spleen and Pancreas 1. To master: Diagnosis of some benign and malignant liver and pancreatic diseases. 2. To master: Differential diagnosis; for example, hepatic cyst, hepatic hemangioma and HCC. 265

3. To be familiar with: Normal appearance of liver, pancreas, and biliary system. To familiarize with CT scan parameter of liver, for example, three phases post-contrast enhanced.

Chapter 9. Genito-urinary System To master 1. To master the general imaging technologies and normal X-ray and CT appearance of the urinary tract system. 2. To master the principal imaging features of urinary tract obstruction. 3. To master the typical imaging findings of positive urinary tract stones To be familiar with To be familiar with the typical findings of renal cell carcinoma and urinary tuberculosis. To understand To understand the typical findings of prostatic enlargement and the general imaging technology and normal appearance of female genital tract system

Chapter 10. Bone, Joint and Soft Tissue To master 1. To master: The classification of bone lesions, the differentiation of benign and malignant bony tumors. 2. To master: The diagnosis of fracture on X-ray film, and the the complications and sequelae of fracture. 3. To master the comparison of osteoarthritis and rheumatoid arthritis. 4. To master the radiological features of spinal tuberculosis. 5. To master the imaging diagnosis in spinal injury. To be familiar with 1. To be familiar with the imaging techniques in bones. 2. To familiar with the classification and healing of fracture. 3. To familiar with the imaging manifestations of spinal degeneration To understand To understand the definitions of the terms in the below table:

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osteoporosis osteomalacia periosteal reaction tumor nest Albright syndrom pepper-salt sign Brodie’s abscess Colles fracture Joint space Spondylolisthesis Intercalation fracture Schmorl’s node

Chapter 11. Central Nervous System To master 1. To master the basic signs of abnormality findings of central nervous system, and remember the CT value of different tissue. 2. To master the differential diagnosis of intracranial tumors. 3. To master the characteristic imaging findings of glioma, meningioma, metastatic tumor on CT, MRI. 4. To master the imaging findings of vascular lesions, such as cerebral hemorrhage, cerebral infarction, AVM, aneurysm on CT and MRI. 5. To master the imaging findings of traumatic lesions, for example, subdural hematoma, epidural hematoma, brain hematoma on CT, MRI. To be familiar with 1. To be familiar with the different imaging modalities in central nervous system and their advantages and disadvantages. 2. To be familiar with the normal performance of the brain, and spinal on X-ray, CT, MRI.

Chapter 12. Head and Neck To master To master the normal imaging findings of the head and neck. To be familiar with To be familiar with the imaging findings of Nasal sinusitis, orbit foreign body, orbit tumors, nasopharyngeal carcinoma, thyroid tumor. To understand To understand the imaging modalities to evaluate the organs and structure of head and neck.

Chapter 13. Interventional Radiology To master

267

To master the definition of interventional radiology. To be familiar with To be familiar with the basic methods, technologies and clinical applications of non-vascular or vascular intervention procedures. To understand To understand the role of interventional tools and materials.

Ⅲ. Practice Requirements Students should attend to the practice course. Everyone must understand the principle of imaging modalities and learn how to observe all kinds of images, be familiar with the observation content and analysis steps, understand the normal imaging findings corresponding on anatomy, and can(be able) describe the basic imaging findings of lesions in different system. Students should master the principle to diagnose a disease according to the imaging modalities, and how to make a differential diagnosis.

Ⅳ. Ability Training Requirements With the application of heuristic teaching, fully mobilizing students' learning initiative and enthusiasm, to guide students thinking independently, learning analysis and synthesis methods of all kinds of information. Medical imaging is a specialty based on images that a diagnosis based on the subject, we must attach importance to image visual teaching, make full use of all kinds of modern teaching technology, such as radiographic images and pathological pictures, the images and anatomy union, to deepen our students understanding the images corresponding on anatomy and diseases, pay attention to practice education.

Ⅴ. Hours Distribution

Content Lecture Discuss Lab 48 16 General theory 3 1 Respiratory system 9 3

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Circulatory system 3 1 Digestive system (Liver, 9 3 Biliary,Pancreatic, Spleen) Genito-urinary system 3 1 Bone, joint and soft tissue 9 3 Central nervous system 6 2 Head and neck 3 1 Interventional Radiology 3 1

Ⅵ.Assessment

Coursework 10% Attendance and Performance 10% Quizzes 10% Clinical Clerkship 20% Final Test 50% Total 100%

Ⅶ.Textbook and references Text Book PETER ARMSTRONG, MARTIN WASTIE, ANDREA ROCKALL. DIAGNOSTIC IMAGING.. SIXTH EDITION. Reference Book Xiao En-hua, Wang Xiao-yi, Feng Gan-sheng, Zhang Xue-lin. Bilingual Medical Image (English to Chinese). First Edition. 2005 Useful web sites http://www.radiologyeducation.com/

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Surgery

Credits: 5+6+5 Total hours: 264 Lectures hours: 164 Experiment hours 100 Grade: 4th Semester: 1, 2 Jiang Xiao-Hua Compiler: Email: [email protected]

Preface The mission of the Surgery Education is to enhance the care of surgical patients and actively promote patient safety through leading-edge educational programs and products that effectively address the needs of practicing surgeons, medical students, surgical patients, and the public. This guidebook is intended for the use by foreign medical students interested in studying clinical medicine at the Southeast University. The intention of the Southeast University Clinical Medical School is to provide students with the ability to further their knowledge in the specific fields of medicine without losing the overview of general theoretical and practical problems. After graduation the students should be able to demonstrate medical competencies and responsibility and inclination toward a clinical speciality. The Chinese edition with information concerning surgery teaching and learning objectives and requirements was last published in 2008. This guidebook is extensively revised and expanded, since the legal requirements for medical practitioners are different from China in English speaking countries (British Commonwealth of Nations), especially due to the introduction of 《Bailey & Love’s SHORT PRACTICE OF SURGERY》as a textbook to our surgical education. The intention of this new guidebook is not only to confer information to medical students, but also to incite teachers and students to take part in the further development of medical education at our university.

Prof. Dr. ZL Ji

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Ⅰ. Preamble and Objectives

The Surgery Curriculum will contain approximately 132 hours of lectures, 40 hours of fundamental surgical skill training, and 44 hours of observation & practice (including operation video disc watching, interactive teaching session, and patient presentation). Besides lectures, basic surgical skill training, and observation & practice, the curriculum encompasses also self-education and 3 months of clerkship in surgical clinic. Surgery normally treats illness by manual or operative methods. The Surgery Curriculum was initiated as a program of an important division of Education of Clinical Medicine to present a basic surgical curriculum for all medical students. The basic forms of disease involveinclude tumors, infections, trauma, congenital or acquired abnormalities and so on. The educational goal of Surgery Curriculum is to ensure that the surgical learners has encountered the most common situations they will face and has learned a safe way to approach each problem. Emphasis is placed on learning “triple-basics” (basic knowledge, fundamental skills and core competencies), such as history-taking, clinical examination-performing, X-ray film-reading, surgical skills, and competencies of differential diagnosis, clinical decision-making and communication with the patients and their families. The requirement intensity of Surgery Course is generally divided into the following 3 levels, high (to master), moderate (to be familiar with), and low (to understand).

Ⅱ. Contents of the Course and Requirements Volume 1. Basic Surgery Chapter 1. INTRODUCTION Learning Objectives 1. To understand the process of surgery 2. To be familiar with the process of history-taking and clinical examination Self-learning history-taking and clinical examination

Chapter 2. DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY Learning Objectives

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1. To recognise the impact of imaging on the diagnostic process 2. To understand the basic principles of the different imaging modalities 3. To be aware of the legal requirements in relation to the use of ionising radiation 4. To understand the basic techniques involved in interventional radiological procedures 5. To gain an overview of the clinical applications of interventional techniques 6. To be familiar with the potential complications of interventional procedures and strategies for their prevention and treatment Self-learning the potential complications of interventional procedures and strategies for their prevention and treatment

Chapter 3. PREPARING A PATIENT FOR SURGERY Learning Objectives 1. To be familiar with the principles involved in preparing a patient for theatre 2. To be familiar with the principles of management of the common problems affecting a patient's fitness for operation Teaching The principles involved in preparing a patient for theatre and management of the common problems affecting a patient's fitness for operation. Self-learning The steps required when taking informed consent from an adult, how to prepare an operating list, and the importance of an operation note.

Chapter 4. ANAESTHESIA, PAIN MANAGEMENT AND CARDIOPULMONARY RESUSCITATION Learning Objectives 1. To understand how to adequately prepare a patient for anaesthesia 2. To master ASA classification (see page 244) 3. To understand the importance of an airway 4. To be familiar with perioperative monitoring and management of general anaesthesia complications 5. To manage the post-anaesthetic patient 272

6. To be familiar with the overdosage manifestations and its prevention and management of common used local anesthetics. To manage the sensible upper dose limits of common used local anesthetic agents 7. To be familiar with the principles and complications of spinal anaesthesia and its prevention and management 8. To be able to manage the patient in pain 9. Correctly master the estimating skills such as accessing airways or taking accurate pulse checks. Master the skills of basic life support (BLS) by practicing the techniques on CPR simulator, mouth-to-mouth ventilation and external chest compression. Teaching 1. general principles, preparation for anaesthesia and premedication, general anaesthesia and its complications, local anaesthesia and its complications, and postoperative pain relief. 2. CPR Self-learning Chronic pain management Observation & Pactice 1. To demonstrate anaesthetic machine and its elementary structure 2. Watching all kinds of anaethesia demonstration via video disc 3. CPR simulation training

Chapter 5. ACUTE LIFE SUPPORT AND CRITICAL CARE: FLUID, ELECTROLYTE AND ACID-BASE BALANCE AND BLOOD TRANSFUSION Learning Objectives 1. To be familiar with the manifestation, diangnosis and management of dehydration, hypokalaemia and hyperkalaemia. 2. To be familiar with the pathophysiology, manifestation, diangnosis and management of metabolic acidosis and metabolic alkalosis 3. To understand managing blood loss and restoration of blood volume 4. To be familiar with the indications for blood transfusion, the complications of blood transfusion and its management 5. To understand the usage of autotransfusion, blood fractions and ,,plasma substitutes 6. To understand 'shock' and its management 273

7. To be able to resuscitate a hypovolaemic patient 8. To appreciate multiple organ failure syndrome, multiple systems organ failure, multiple organ dysfunction syndrome and systemic inflammatory response syndrome Teaching Fluid balance, electrolyte balance, acd-base balance, haemorrhage, transfusion of blood and blood products, shock and multiorgan failure.

Chapter 6. NUTRITION Learning Objectives 1. To understand nutritional requirements in health and how they are influenced by disease 2. To recognise the consequences of malnutrition in surgical patients 3. To know how to assess nutritional status in surgical patients 4. To know the indications for and principles of nutritional support 5. To recognise potential complications of nutritional support Teaching Nutritional status assessment and nutritional support

Chapter 7. WOUNDS, TISSUE REPAIR AND SCARS Learning Objectives 1. To understand the process of primary wound healing and healing by secondary intention 2. To be able to explain the different management of a 'tidy' and 'untidy' wound 3. To understand the pathophysiology of acute and chronic wounds 4. To understand the nature of adverse scarring and its treatment Teaching Wound healing, wound classification, wound debridement and injury to internal organs Self-learning Types of wound, chronic wound and scars

Chapter 8. BASIC SURGICAL SKILLS AND ANASTOMOSES Learning Objectives 1. To understand surgical approaches and incisions and the use of appropriate instruments 2. To know the materials and methods used for wound closure and anastomoses (sutures, knots 274

and needles) 3. To be able to describe the indications for alternative technologies (glues and staples) 4. To know the techniques for skin artery and bowel closure and anastomoses Teaching The Basic Surgical Skill training encompasses ten learning sessions each four hours long. Students are encouraged to discuss anything that varies from the practice with their program director.

Chapter 9. PRINCIPLES OF LAPAROSCOPIC SURGERY Learning Objectives 1. To understand the principles of laparoscopic surgery 2. To be aware of the advantages and disadvantages of this type of surgery 3. To prepare a patient safely for laparoscopic surgery 4. To learn the procedures when laparoscopic surgery is appropriate 5. To care for the patient postoperatively Self-learning General intraoperative principles

Chapter 10. WOUND INFECTION Learning Objectives 1. To know the definition of Koch's postulates 2. To be familiar with physiology and manifestation of surgical infection 3. To appreciate the importance of aseptic technique and of delayed closure in contaminated wounds 4. To be aware of the causes of reduced resistance to infection 5. To understand the factors that determine whether a wound will become infected 6. To know the definitions of infected states 7. To understand the classification of sources of infection and their severity 8. To be able to describe the management of abscesses 9. To be able to state the indications for and choice of prophylactic antibiotics 10. To know what basic precautions to take to avoid nosocomial infections 11. To understand the characteristics of the common pathogens and their sensitivities 12. To be able to describe the spectrum of commonly used antibiotics 275

13. To be familiar with the principles of antimicrobial treatment in surgery Self-learning Physiology and manifestation of wound infection, types and classifications of wound infection, treatment and prophylaxis

Chapter 11. STERILE PRECAUTIONS AND THEATRE SAFETY Learning Objectives 1. To understand the importance and current status of decontamination of surgical instruments and equipment in the context of safe surgery 2. To appreciate the necessity for strict adherence to operating theatre protocols in order to limit adverse events that are so costly in terms of patient morbidity and hospital medico-legal involvement 3. To recognise that satisfactory surgical outcomes after operation require training not only in the technique but also in the use of operating theatre equipment, for example electro-surgery 4. To realise that modern surgery is founded on the control of infection 5. Clearly distinguishing among hygiene, sterile, nonsterile, and aseptic. Mastering the rationale for practicing surgical aseptic technique and practice the rules of aseptic technique, including the surgical hand scrub, donning gown and gloves, skin preparation and draping. Teaching The Basic Surgical Skill training encompasses ten learning sessions each four hours long. Students are encouraged to discuss anything that varies from the practice with their program director.

Chapter 12. PARASITIC INFECTIONS Learning Objectives 1. To understand the role of parasitic infections in surgical practice 2. To be able to diagnose infections 3. To describe the treatment of the surgical patient 4. To use this chapter as a source of reference 5. To think of parasitic infections

Chapter 13. ACQUIRED IMMUNODEFICIENCY SYNDROME Learning Objectives 276

1. To understand the aetiology, pathogenesis and natural history of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) 2. To understand the clinical presentation of the disease, particularly to the surgeon 3. To appreciate the management of the common problems that present to the surgeon 4. To understand the risks of infection from patient to surgeon and vice versa, and know how to reduce these risks Teaching anal diseases, the acute abdomen in AIDS, and risk of transmission of HIV disease from patient to surgeon Self-learning lymphoma, splenectomy and infection of the patient by the surgeon

Chapter 14. TRANSPLANTATION Learning Objectives 1. To appreciate the immunological basis of allograft rejection 2. To know the principles of immunosuppressive therapy 3. To be aware of the side-effects of non-specific immunosuppression 4. To be familiar with the major issues concerning organ donation 5. To know the main indications for organ transplantation 6. To know the surgical principles of organ implantation 7. To be able to give an account of the causes of graft dysfunction 8. To be aware of the likely outcomes after transplantation 9. To be aware of future developments in transplantation Teaching allograft rejection, immunosuppressive therapy, complications of immunosuppression, organ donation and kidney transplantation Self-learning hitocompatibility testing and screening for presentisation to HLA and future prospects

Chapter 15. CYSTS, ULCERS AND SINUSES Learning Objectives 1. To be able to differentiate between true and false cysts 277

2. To understand the basic principles of ulcer management 3. To understand the difference between sinuses and fistulae, and the principles of the management of commonly encountered sinuses Self-learning cysts, ulcers and sinuses

Chapter 16. PRINCIPLES OF ONCOLOGY Learning Objectives 1. To understand carcinogenesis, the molecular genetics of cancer, tumour kinetics and mechanisms of invasion and metastases 2. To be familiar with the principles of tumour staging 3. To be familiar with the principles of screening for cancer 4. To be familiar with the principles of cancer surgery 5. To understand the principles of radiotherapy 6. To understand the principles of chemotherapy and hormonal therapy 7. To appreciate the potential of new forms of treatment 8. To have a working knowledge of the principles of palliative care Teaching mechanisms of invasion and metastases, tumour staging, screening for cancer, cancer surgery, radiotherapy, chemotherapy and hormonal therapy Self-learning carcinogenesis, the molecular genetics of cancer, and tumour kinetics

Chapter 17. DAY SURGERY Learning Objectives 1. To understand what is meant by the term 'day surgery' 2. To appreciate the benefits and disadvantages of day surgery 3. To know the features of an ideal day-surgery unit 4. To be able to select suitable day-surgery procedures 5. To be able to select and assess suitable day-case patients 6. To master ASA classification 7. To know the methods of assessing patients 278

8. To be able to choose appropriate anaesthesia and analgesia for day-surgery patients 9. To know discharge criteria Teaching the benefits and disadvantages of day surgery and the essentials of good day surgery Self-learning definition, postoperative morbidity after day surgery

Chapter 18. AN APPROACH TO SURGICAL AUDIT Learning Objectives 1. To appreciate that audit is a fundamental part of modern surgical practice 2. To acknowledge that there are some very real differences between the traditional audit model and the one that is usually adopted in surgical practice 3. To understand the key elements that constitute the audit cycle or process 4. To appreciate some of the complexities of comparing surgical practice

Chapter 19. CLINICAL TRIALS AND STATISTICS Learning Objectives 1. To be able to review a journal article and determine its good and bad points 2. To be able to plan a research project in surgery 3. To be able to write up your research 4. To have the enthusiasm to get started

Chapter 20. SURGICAL ETHICS Learning Objectives 1. To introduce the moral importance of the concept of autonomy to good surgical practice 2. To evaluate the moral and legal boundaries of the doctrine of informed consent 3. To explain and illustrate some practical difficulties in implementing the doctrine of informed consent 4. To outline good surgical practice in withholding and withdrawing life-saving treatment 5. To specify the importance and boundaries of confidentiality in good surgical practice 6. To indicate why surgical research should be subject to independent evaluation and how to differentiate between such research and minor surgical innovation 279

7. To assess the moral importance of rigorous surgical training and a willingness to criticise fellow surgeons in the face of bad practice Teaching Informed consent and maintaining standards of excellence Self-learning Respect for autonomy, practical difficulties, matters of life and death, confidentiality and maintaining standards of excellence

Chapter 21. PLASTIC AND RECONSTRUCTIVE SURGERY Learning Objectives 1. To understand the application of plastic surgery techniques to wound closure 2. To be aware of the importance of blood supply and anatomy in plastic surgery 3. To know about skin grafts and their clinical uses 4. To be able to distinguish between different types of flaps 5. To use the '' to think logically about the closure of defects 6. To be familiar with different types of skin grafts and its indications. Teaching Reconstructive ladder, plastic surgery priciples, and different types of skin grafts and its indications Self-learning Different types of flaps and its indications

Chapter 22. BURNS Learning Objectives 1. 1. To understand the pathophysiology of burn injury and its dynamic changes 2. 1. To master the methods for assessing area and depth of burns 3. 2. To be familiar with the methods for calculating rate and quantity of fluids to be given 4. 3. To appreciate the techniques for treating burns and the patient 5. 4. To understand the pathophysiology of electrical and chemical burns Teaching The pathophysiology of burn injury, the methods for assessing area and depth of burns, the methods for calculating rate and quantity of fluids to be given, burn wound management and complication management, electrical burn and chemical burn 280

Observation & Pactice Burn case demonstration and opeartiondemonstration from video disc.

Chapter 23. ACCIDENT AND EMERGENCY SURGERY Learning Objectives 1. To recognise the importance of injury in terms of human and economic cost 2. To understand the importance of injury prevention 3. To be familiar with common patterns of injury after trauma 4. To master a framework for the initial assessment and treatment of wounded patients 5. To obtain an introduction to modern concepts of trauma surgery and critical care Teaching Epidemiology, causes of trauma, trauma care system, systems injuries and damage control surgery Self-learning Paediatric trauma, trauma care system, systems injuries and modern concepts of trauma surgery and critical care

Chapter 24. WARFARE IN|URIES Learning Objectives 1. To understand the epidemiology of warfare injuries 2. To know the fundamentals of wound ballistics and injury mechanisms 3. To understand the principles of wound management 4. To understand injury mechanisms following exposure to blast phenomena 5. To recognise typical clinical features and injury patterns in blast victims 6. To have a sound grasp of management principles when dealing with blast victims Teaching the epidemiology of warfare injuries and blast injuries Self-learning wound ballistics and injury mechanisms, and missile injury

Chapter 25. POSTOPERATIVE CARE Learning Objectives 1. To appreciate the importance of a care plan in the support for a patient after surgery 281

2. To master WHO analgesic ladder and know how to provide adequate postoperative pain relief 3. To be familiar with the management of complications through prophylaxis monitoring and contingency 4. To be able to describe the routine for postoperative review of patients using SOAP (subjective, objective, active problems and plan) 5. To know the structure for writing up postoperative notes 6. To master identifing and managing the more important postoperative complications Teaching care plan in the support for a patient after surgery, SOAP (subjective, objective, active problems and plan), complications and its management, post operative fluid therapy. Self-learning postoperative pain management and discharge letters

APPENDIX—TETANUS Learning Objectives To understand the clinical features, treatment and prevention of tetanus Teaching pathogenesis, clinical features, diagnosis, treatment and prevention Self-learning wound management

Volume 2. Orthopedics Chapter 26. CLINICAL EXAMINATION IN MUSCULOSKELETAL DISORDERS Learning Objectives 1. To understand the three major types of history, their functions and the different ways in which they are obtained 2. To understand the three zones of abnormality that a history should address 3. To know a simple system for examining the musculoskeletal system 4. To learn the specific features to be sought in each area of the body

Chapter 27. MUSCULOSKELETAL IMAGING Learning Objectives 282

1. To be able to list the advantages and risks of plain radiography, computerised tomography, magnetic resonance imaging, ultrasound and isotope scanning when imaging the musculoskeletal system 2. To understand how to write a good imaging request card 3. To know the law in relation to radiation

Chapter 28. FRACTURES AND DISLOCATIONS Learning Objectives 1. To know how to investigate a patient who may have a fracture or dislocation 2. To master fracture patterns, manifestation, and classifications. To be able to describe a fracture or dislocation concisely and correctly. 3. To understand the principles of reduction and holding a fracture or dislocation 4. To master the common complications of fractures and dislocations, and how to check for them 5. To be familiar with the basic pathophysiology of fracture healing Teaching Fracture patterns, manifestation, and classifications. The basic pathophysiology of fracture healing. Principles of fracture management. The common complications of fractures and dislocations. Observation & Pactice Case showing, X-ray film and management (reduction, fixation and rehabilitation) demonstration by video disc.

Chapter 29. PROBLEMS IN THE SHOULDER AND ELBOW Learning Objectives 1. To understand the anatomy and physiology of the upper limb in relation to the problems that can occur and their treatment 2. To be familiar with the diagnosis and treatment of common problems around the shoulder, such as rotator cuff syndrome, dislocation and fractures 3. To be able to diagnose and treat problems around the elbow, with special reference to fractures in children 4. To appreciate the differences between adults and children in trauma involving the shoulder and elbow 283

5. To master the diagnosis and treatment of humeral shaft fracture and Colles’ fracture. 6. To master the diagnosis and treatment of humeral shaft fracture Teaching The painful shoulder, frozen shoulder, traumatic dislocation of shoulder, tennis elbow, fractures of the upper limb (clavicle, humerus, radius, ulna), elbow dislocation. Self-learning The anatomy and physiology of the shoulder and elbow. Olecranon bursitis. Ulnar nerve compression. Infection of the upper limb. Observation & Pactice Case showing, X-ray film and management (reduction, fixation and rehabilitation) demonstration by video disc.

Chapter 30. PELVIC AND ACETABULAR FRACTURES Learning Objectives 1. To be able to recognise pelvic and acetabular fractures and master the principles of classifying injury patterns and complications 2. To understand the principles of clinical evaluation and effective and appropriate emergency management 3. To know the indications for surgical intervention and the roles of external and internal fixation 4. To understand the principles of surgical exposure and fixation, with common complications 5. To be aware of the rates of mortality, morbidity and long-term functional outcome Teaching Classification, management Observation & Pactice Case showing, X-ray film and management (reduction, fixation and rehabilitation) demonstration by video disc.

Chapter 31. LOWER LIMB TRAUMA Learning Objectives 1. To understand the importance of a careful history in determining the energy and likely associated injuries involved in the trauma 284

2. To appreciate the importance of careful examination, including neurovascular status 3. To be able to establish a treatment plan for specific injuries 4. To consider amputation where reconstruction is impossible or inadvisable and the importance of avoiding delay in making that decision 5. To master the diagnosis and treatment of femoral neck fracture and tibial fracture 6. To be familiar with the diagnosis and treatment of the subtrochanteric fracture and hip dislocation Teaching Intracapsular fractures, extracapsular fractures, hip dislocation, fractures around the knee, compartment syndrome and ankle injuries Self-learning Metaphyseal fractures and amputation Observation & Pactice Case showing, X-ray film and management (reduction, fixation and rehabilitation) demonstration by video disc.

Chapter 32. SURGERY FOR ARTHRITIS IN THE HIP AND KNEE Learning Objectives 1. To understand the problems most commonly affecting the hip joint in each age group 2. To understand the biomechanics of the hip and knee joints 3. To understand the reason for the rapid rise in the need for revision surgery 4. To list the basic options in the design and insertion of hip and knee replacements 5. To give reasons and indications for joint replacement and its options, including non-operative 6. To describe how a hip and knee replacement is performed and managed perioperatively Teaching Results of total joint replacement. Principles of design of a joint replacement. Pros and cons of hip and knee replacement. Postoperative care for total hip replacement Self-learning Epidemiology of arthritis of the major joints. Total knee arthroplasty. Treatment of primary osteoarthritis of hip

Chapter 33. DISEASES OF BONES AND JOINTS: INFECTION 285

Learning Objectives 1. To know the common microbial causes of bone and joint infection 2. To understand the distinction between infection, colonisation and contamination, and the relevance of these to bone and joint infection 3. To understand the principles of empiric and culture-directed antibiotic selection 4. To know how to manage acute septic arthritis, acute osteomyelitis and an acutely infected orthopaedic implant (fracture fixation and prosthetic joint) 5. To know the common surgical techniques in use for treatment of chronic long bone osteomyelitis and chronic prosthetic joint infection 6. To master the early diagnosis and treatment of acute bone and joint infection 7. To be familiar with the pathogenesis, diagnosis and treatment of chronic bone and joint infection Teaching Acute and chronic bone and joint infection, including pathogenesis, diagnosis and treatment. Observation & Pactice Case showing, X-ray film and management (reduction, fixation and rehabilitation) demonstration by video disc.

Chapter 34. BONE TUMOURS Learning Objectives Learning Objectives 1. To be familiar with the cardinal features of the history, classification of bone tumours and examination that distinguish benign from malignant tumours 2. To understand the value of investigations for defining and staging tumours 3. To understand the reasons for referral of suspicious lesions to a centre specialising in musculoskeletal turnout treatment 4. To understand the reason why bones at risk of a pathological fracture should be fixed prophylactically 5. To understand the clinical features, radiological diagnosis and treatment of osteochondroma, chondroma, giant cell tumour and osteosarcoma Teaching Bone tumour classification, investigation and differential diagnosis. The clinical features and treatment of benign bone tumours (osteochondroma, chondroma, giant cell tumour), malignant 286

tumours and secondary tumours. Self-learning Soft-tissue tumours Observation & Pactice Case showing, X-ray film and management (reduction, fixation and rehabilitation) demonstration by video disc, especially in the distinguish benign from malignant tumours.

Chapter 35. DISEASES OF THE BONES, JOINTS AND CONNECTIVE TISSUES Learning Objectives 1. To be able to describe a minimal screen for the locomotor system, based on gait, arms, legs, spine (GALS) 2. To understand the link in pathological terms between genetic mutations and disorders of the musculoskeletal system 3. To be able to describe the characteristics of the history and findings on examination of a patient with rheumatoid arthritis, systemic lupus erythematosus, reactive arthritis and gout 4. To be able to describe the characteristics of the history and findings on examination and underlying pathophysiology of osteoarthritis 5. To be able to describe the causes and consequences of osteoporosis with the appropriate investigation and treatment options 6. To be able to explain the cause of rickets, the underlying pathophysiology, its investigation and treatment 7. To understand the clinical features, diagnosis and treatment of rheumatoid arthritis and osteoarthritis Teaching Rheumatoid arthritis and osteoarthritis Self-learning Heritable disorders of the skeleton and connective tissues and metabolic bone diseases

Chapter 36. PAEDIATRIC ORTHOPAEDICS: NORMAL DEVELOPMENT AND CONGENITAL DISORDERS Learning Objectives 1. To understand the use of the '5Ss' to distinguish normal variants from pathology in children's 287

orthopaedics 2. To understand how limb deformities can be classified by how they arise 3. To be able to explain the principles of treatment of club foot 4. To be able to describe how developmental dysplasia of the hip is caused, diagnosed and treated according to age 5. To be able to list the common forms of dwarfism Self-learning Normal variants, flat foot, congenital talipes equines varus (CTEV) and developmental dysplasia of hip (DDH).

Chapter 37. PAEDIATRIC ORTHOPAEDICS: DISEASES OF THE GROWING SKELETON Learning Objectives 1. LEARNING OBIECTIVES: 2. To understand the pathophysiology, diagnosis and treatment of major hip problems in children - Perthes' disease and slipped upper femoral epiphysis 3. To understand the pathophysiology, diagnosis and treatment of septic arthritis and osteomyelitis in children 4. To understand the pathophysiology, diagnosis and treatment of the common neuromuscular problems in children, including cerebral palsy and spina bifida 5. To master the early diagnosis and treatment of acute bone and joint infection 6. To master the early diagnosis and treatment of bone and joint tuberculosis Teaching Perthes' disease, acute bone and joint infection, skeletal tuberculosis, torticollis (wry neck), and scoliosis Self-learning Neuromuscular orthopaedics

Chapter 38. SPORTS MEDICINE AND BIOMECHANICS Learning Objectives 1. To be able to define the simple terms used in biomechanics 2. To be able to describe the unique features of a history and examination in sports medicine 288

3. To be able to make a treatment plan for management of injury to muscle, tendon and ligament and bone in sports medicine 4. To know the most common diagnoses in sports medicine of knee, ankle, groin, shoulder and elbow problems Teaching Stress fractures, meniscal tears, ligament injuries of the knee and epicondylitis Self-learning Diagnoses of sports injuries, bursae, groin pain and ankle

Chapter 39. WRIST AND HAND Learning Objectives 1. To know the five major forms of grip in the hand 2. To understand the specific features of the history, examination and investigation in the hand and wrist 3. To be familiar with the key principles of treatment in the hand 4. To understand the importance of early mobilisation and the methods used to achieve this 5. To know indications and contraindications of replantation 6. To master the diagnosis and treatment of Colles’ fracture. 7. To master the key principles of diagnosis and treatment of hand infections. Teaching Basic principles of treatment in the hand, distal radius fractures, fingertip injuries, indications and contraindications of replantation, hand infections and tendon disorders Self-learning Function and assessment, dislocations and arthritis

Chapter 40. THE FOOT Learning Objectives 1. To understand the principles of treatment of talipes equinovarus and other common congenital deformities of the foot 2. To be able to recognise and treat pes cavus 3. To know the causes and treatment of infection in the foot 4. To understand the management of arthritis in the foot 289

5. To know the treatment options in hallux valgus and other common deformities of the forefoot Self-learning Talipes equinovarus, major infections, hallux valgus

Chapter 41. NEUROLOGICAL DISORDERS AND THE MUSCULOSKELETAL SYSTEM Learning Objectives 1. To understand the approach to neurological conditions based on anatomical distribution and neurological pattern 2. To be able to describe the neurological assessment of patients with neuromuscular disorders, including assessment of contractures 3. To be aware of the main indications for surgical treatment of neurological patients and the need to have specific targets and aims 4. To develop a high index of suspicion for neurological conditions that can present as orthopaedic problems: high-arched foot (cavovarus), late development of tiptoe walking, clawing of the toes, foot drop 5. To know the specific surgical needs of the most common neurological conditions: cerebral palsy, stroke and head injury, poliomyelitis and peripheral neuropathies

Chapter 42. THE SPINE, VERTEBRAL COLUMN AND SPINAL CORD Learning Objectives 1. To understand how to manage the spine of a polytrauma patient until significant injury is excluded 2. To understand the diagnosis and treatment of spinal trauma, infection and tumour 3. To know how to interpret the history and examination of the spine to create a differential diagnosis and to exclude inappropriate response to pain 4. To know the strengths and weaknesses of magnetic resonance imaging, computerised tomography and plain radiography in the diagnosis of back problems 5. To be familiar with primary survey and management of the patient with spinal injuries, especially with cervical spinal fracture. 6. To master the clinical manifestation, diagnosis and treatment of lumbar or cervical disc prolapse. 290

Teaching Assessment of the spine, cervical spine injuries, thoracic and thoracolumbar fractures, cervical and lumbar spinal disc prolapse Self-learning Anatomy of the spinal and spinal cord Observation & Pactice case showing, X-ray film and management (reduction, fixation and rehabilitation) demonstration by video disc, especially in the reduction, fixation and rehabilitation for patients with spine injuries.

Volume 3. Otorhinolaryngology, Head and Neck, Cardiothoracic and Endocrine Surgery Chapter 43. THE EYE AND ORBIT Learning Objectives 1. To have a better understanding of common ocular disorders 2. To recognise ophthalmic symptoms and specific signs 3. To appreciate the value of special tests and investigations 4. To know when specialist referral is appropriate

Chapter 44. CLEFT LIP AND PALATE: DEVELOPMENTAL ABNORMALITIES OF THE FACE, MOUTH AND JAWS Learning Objectives 1. To understand the aetiology and classification of cleft lip and palate 2. To be able to describe the principles of reconstruction of cleft lip and palate 3. To understand the key features of the perioperative care of the child with cleft lip and palate 4. To know the associated complications of cleft lip and palate and their management

Chapter 45. MAXILLOFACIAL INJURIES Learning Objectives 1. To be able to recognise the life-threatening nature of facial injuries through compromise of the airway and associated head and spinal injuries 2. To have a methodology for examining facial injuries 291

3. To know the classification of facial fractures 4. To understand the diagnosis and management of fractures of the middle third of the facial skeleton and the mandible 5. To appreciate the importance of careful cleaning and accurate suturing of facial lacerations

Chapter 46. THE NOSE AND SINUSES Learning Objectives 1. To understand the basic anatomy of the nose and paranasal sinuses 2. To know the principles of managing post-traumatic nasal and septal deformity 3. To know the causes and treatment of epistaxis 4. To be familiar with the diagnosis and treatment of nasal polyposis 5. To recognise the clinical features of sinus infection and understand its treatment and potential complications 6. To be conversant with the common sinonasal tumours, their presentation, investigation and principles of treatment

Chapter 47. THE EAR Learning Objectives 1. To understand the basics of the anatomy, namely the outer layer of the eardrum migrates outwards; when the skin grows into the middle ear, a cholesteatoma results 2. To know how the facial nerve can be damaged by trauma and disease in relation to the route it takes through the ear 3. To know that the most common cause of intracranial sepsis is ear disease, and the reasons for this 4. To be able to distinguish between the causes of conductive hearing loss and sensorineural hearing loss in relation to the anatomy and physiology of the ear 5. To know the tests needed to distinguish outer ear conditions from middle ear disease 6. To be able to distinguish the two types of chronic suppurative otitis media, namely tubotympanic and atticoantral disease 7. To recognise the presenting symptoms of an acoustic neuroma tumour

Chapter 48. ORAL AND OROPHARYNGEAL CANCER 292

Learning Objectives 1. To understand that 90% of all oral cancers result from the use of tobacco and alcohol 2. To be able to give the cardinal features of cancer arising in the oral cavity and oropharynx 3. To be able to undertake and interpret the routine investigation of a patient with oral cancer 4. To understand the principles of management of a patient with oral/oropharyngeal cancer and select the appropriate treatment

Chapter 49. DISORDERS OF THE SALIVARY GLANDS Learning Objectives 1. To understand the anatomy of the salivary glands in relation to nerves, arteries and veins, with special emphasis on the facial nerve in relation to the parotid gland 2. To recognise the characteristic features of the history, and examination and appropriate investigation of the salivary glands 3. To be able la describe the key features of the medical and surgical treatment of stone, infection and tumour in the salivary glands

Chapter 50. PHARYNX, LARYNX AND NECK Learning Objectives 1. To know the relevant anatomy and physiology of the pharyngolarynx and neck in order to understand the disease process involving them 2. To choose the relevant investigations to add to the clinical features, enabling accurate diagnosis 3. To have a clear understanding of the diagnosis and emergency treatment of airway obstruction 4. To understand the benign and malignant tumours that involve these structures, in particular the aetiology, prevention, natural history and management of squamous carcinoma of the upper aerodigestive tract

Chapter 51. THE THYROID GLAND AND THE THYROGLOSSAL TRACT Learning Objectives 1. To understand the development and anatomy of the thyroid gland 2. To know the physiology and investigation of thyroid function 3. To be able to select appropriate investigations for thyroid swellings 293

4. To master the aetiology, clinical features, diagnosis, indications for operation, and procedure option of simple goitre 5. To be familiar with diagnosis and management of discrete thyroid swellings. To know when to operate on a thyroid swelling 6. To be familiar with how to manage hyperthyroidism (diagnosis, indications for operation, preoperative preparation, principles of surgery, postoperative complications and its management) 7. To describe thyroid lobectomy 8. To be familiar with the risks and complications of thyroid surgery, and their management 9. To be aware of and have a view on the controversies surrounding the management of thyroid cancer Teaching Ectopic thyroid and anomalies of the thyroglossal tract, thyroid swelling, hyperthyroidism, and neoplasms of thyroid Self-learning Embryology, physiology, and tests of thyroid function Observation & Pactice To have a case presentation by video disc of thyroid swelling, hyperthyroidism, and neoplasms of thyroid, including laboratory parameters, X-ray films, CT film and pathology.

Chapter 52. PARATHYROID AND ADRENAL GLANDS Learning Objectives 1. To know the surgical concepts of parathyroid and adrenal disorders 2. To understand the investigation of parathyroid and adrenal disorders 3. To appreciate the role of surgery in parathyroid and adrenal disorders 4. To understand the management of parathyroid and adrenal cancers

Chapter 53. THE BREAST Learning Objectives 1. To understand lymph drainage pattern 2. To master appropriate investigation of the breast, and breast mass differential diagnosis 3. To be aware of breast anomalies 294

4. To understand the complexity of benign breast disease 5. To be familiar with the diagnosis, prevention and treatment of bacterial mastitis 6. To master an in-depth knowledge of breast cancer, especially clinical features and the principles of surgical treatment Teaching Investigation of breast, the nipple, benign breast disease, and carcinoma of the breast Self-learning Comparative and surgical anatomy Observation & Pactice To have a case presentation by video disc of breast mass, including laboratory parameters, X-ray films, CT film and pathology.

Chapter 54. THE THORAX Learning Objectives 1. To be able to apply knowledge of anatomy and physiology to the care of the chest patient 2. To understand the specific role of the surgeon in the investigation of chest pathology 3. To be aware of the breadth of surgical expertise in chest disease 4. To be aware of the rarer surgical conditions 5. To be familiar with the aetiology, clinical features, diagnosis and treatment of bulae or air cysts, spontaneous pneumothorax, and tension pneumothorax 6. To understand the inserting and managing a chest drain (underwater seal chest drain bottle) 7. To be familiar with the aetiology, clinical features, diagnosis and treatment of empyema 8. To master the aetiology, histological classification, clinical features, early diagnosis and principles of treatment of lung cancer 9. To understand surgical oncology as applied to chest surgery 10. To be familiar with the subdivision of the mediastinum with the most common mediastinal masses, and their clinical features, diagnosis and management 11. To understand surgical treatment and surgical indications of bronchiectasis, and tuberculosis 12. To master the pathophysiology, clinical features, indications for thoracotomy, and emergency management of chest trauma 13. To be familiar with the clinical features, diagnosis and emergency management of the rib fractures, traumatic pneumothorax, and traumatic haemothorax 295

14. To have confidence in the management of chest trauma 15. To understand the aetiology, histology, clinical features, diagnosis and principles of treatment of the chest wall tumours, and pigeon chest Teaching Pneumothorax, empyema, primary lung cancer, primary tumours of the mediastinum, bronchiectasis, tuberculosis, chest trauma, and chest wall Self-learning Pulmonary sequestration, presentation of lung disease, and diaphragm Observation & Pactice to have a case presentation by video disc of chest trauma, including laboratory parameters, X-ray films, CT film and pathology. underwater seal chest drain bottle.

Chapter 55. CARDIAC SURGERY Learning Objectives 1. LEARNING OBIECTIVES: 2. To be introduced to the important role of surgery in cardiac disease 3. To appreciate the emphasis on the role of exact investigation in planning surgery 4. To understand the important role of surgery and other techniques in the management of coronary heart disease 5. To be introduced to the role of surgery in heart valve disorders 6. To be aware of the specialism of the surgery of congenital heart disease 7. To be aware of the impact of cardiac disease on surgical outcome Teaching Cardiopulmonary bypass, coronary artery bypass surgery and indications for surgery, valvular heart disease, and congenital heart disease Self-learning The thoracic aorta Observation & Pactice To have a case presentation by video disc of heart disease, including laboratory parameters, X-ray films, ultrasonography, CT film and pathology. underwater seal chest drain bottle

Chapter 56. THE OESOPHAGUS 296

Learning Objectives 1. To understand the anatomy and physiology of the oesophagus and their relationship to disease 2. To understand the aetiology, clinical features, diagnosis, and treatment of corrosive injury 3. To understand the aetiology, clinical features, diagnosis, and treatment of GORD (gastro-oesophageal reflux disease) 4. To understand the clinical features, investigations and treatment of benign and malignant disease, with particular reference to the common disorders, i.e. trauma, gastro-oesophageal reflux disease (including hiatus hernia), Barrett's disease, dysmotility (including achalasia) and malignancy 5. To master the aetiology, clinical features, investigations, diagnosis, differential diagnosis, and treatment of carcinoma of the oesophagus 6. To understand the aetiology, pathology, clinical features, diagnosis, and treatment of achalasia Teaching GORD (gastro-oesophageal reflux disease) and carcinoma of the oesophagus Self-learning Surgical anatomy and physiology, congenital abnormalities, barotraumas (Boerhaave syndrome), corrosive injury, and achalasia Observation & Pactice To have a case presentation by video disc of carcinoma of the oesophagus, including laboratory parameters, X-ray films, ultrasonography, CT film and pathology.

Volume 4. Neurosurgery, Urinary and Vascular Surgery Chapter 57. NERVES Learning Objectives 1. To understand the structure of a peripheral nerve and its response to injury 2. To know the clinical features of nerve disorders 3. To be familiar with the principles of management of open and closed injuries to peripheral nerves and of nerve compression syndromes Teaching Sunderland and Seddon classification of nerve injuries, MRC classification of motor nerve dysfunction, and surgical repair

297

Chapter 58. CRANIOCEREBRAL TRAUMA Learning Objectives 1. To appreciate the importance of head injury in terms of morbidity and mortality 2. To understand that the way in which the trauma occurs determines the type of injury 3. To know that the key to minimising secondary injury to brain tissue is to ensure that the brain is well perfused with well-oxygenated blood 4. To be familiar with the clinical features, diagnosis, and the principles of management of skull fractures 5. To master the pathophysiology, clinical features, diagnosis, and the principles of management of primary brain injury 6. To be familiar with the clinical features, and differential diagnosis of intracranial haematomas, especially extradural haematoma. 7. To understand the principles of management of intracranial haematomas 8. To understand the mechanism and aetiology of intracranial hypertension 9. To be familiar with the mechanism of brain hernia formation, its clinical features and principles of management Teaching Pathophysiology of head injuries, skull fractures, brain injuries (primary and secondary), and intracranial hypertension, especially intracranial haematomas Observation & Pactice To have a case presentation by video disc of head trauma, including laboratory parameters, X-ray films, CT film and pathology.

Chapter 59. ELECTIVE NEUROSURGERY Learning Objectives 1. To understand the pathophysiology of raised intracranial pressure and hydrocephalus 2. To know the common causes, presentations, investigation and treatment options for the three intracranial infections, meningitis, brain abscess and subdural empyema 3. To be able to describe the common features of presentation investigation and treatment of intracranial tumours 4. To be able to understand the diagnosis and management of intracranial haemorrhage 5. To be able to define the role of surgery in the management of epilepsy 298

6. To understand the principles involved in defining brain death Teaching Intracranial tumours, subarachnoid haemorrhage and aneurysms Observation & Pactice Intracranial infections, and epilepsy

Chapter 60. URINARY SYMPTOMS, INVESTIGATION OF THE URINARY TRACT AND ANURIA Learning Objectives 1. To be able to list the major symptoms of urological disease 2. To be able to list the most commonly used investigations for urological conditions 3. To recognise symptoms of urinary disease Observation & Pactice To introduce and present the imaging studies, cystoscopic investigation and retrograde ureterogram by video disc

Chapter 61. THE KIDNEYS AND URETERS Learning Objectives 1. To be able to list the major types of congenital abnormality of the upper urinary tract 2. To recognise the major types of cystic disease of the kidney 3. To be able to describe the presentation, diagnosis and management of open and closed trauma to the kidney and ureter 4. To understand the aetiology, pathophysiology, presentation and surgical management of obstruction to the upper urinary tract 5. To be able to list the main types of renal calculi and the aetiology of their formation 6. To master the main symptoms, diagnosis, modern management and prevention of urinary tract calculi 7. To be familiar with the interactive relationship of infection, calculus can obstruction 8. To be able to describe the aetiology, presentation and management of sepsis in the upper urinary tract 9. To understand the central role of kidney in the urinary tract tuberculosis 10. To be familiar with the clinical features, diagnosis and treatment of renal tuberculosis and 299

their complications 11. To be able to list the major types of renal neoplasm and the clinical signs and symptoms associated with them 12. To be familiar with the clinical features, diagnosis and surgical management of tumours of the upper urinary tract Teaching Injury to the kidney and ureter, hydronephrosis, surgical treatment of urinary calculi and ureteric calculi, kidney infection, renal tuberculosis, and neoplasms of the kidney Self-learning Congenital abnormality of the upper urinary tract,

Chapter 62. THE URINARY BLADDER Learning Objectives 1. To appreciate the relationship of surgical anatomy, vascular supply and nerve innervation of the bladder to disorders of function and development of disease 2. To be able to classify bladder trauma, urinary incontinence and urinary fistulae formation and to gain an awareness of the principles of surgical management of these conditions 3. To understand the clinical features, diagnosis, and principles of management of bladder trauma 4. To know the common causes of acute and chronic urinary retention and to understand the management of the bladder in patients following retention and in patients with spinal cord injury 5. To master the main clinical features, diagnosis, principles of management and prevention of bladder stones 6. To be able to classify bladder cancer and be aware of the distinction between superficial and invasive disease 7. To master the clinical features, diagnosis, and treatment options for superficial and invasive disease and be aware of the different types of urinary diversion Teaching Bladder trauma, retention of urine, bladder stones, lower urinary infection and cystitis, tuberculous urinary infection, and carcinoma of the bladder Self-learning 300

Surgical anatomy, congenital defects, and incontinence of urine

Chapter 63. THE PROSTATE AND SEMINAL VESICLES Learning Objectives 1. To understand the relationship of anatomical structure and biochemical function to development and treatment of benign and malignant disease of the prostate 2. To recognise the terminology used to describe lower urinary tract symptoms and to know their causes as well as the treatment options available 3. To master the diagnosis and principles of management of benign prostatic hyperplasia. To know the common causes of acute urine retention 4. To know which investigations are appropriate for carcinoma of the prostate 5. To understand clinical staging of carcinoma of the prostate and how staging contributes to the complex decision-making process for best treatment option 6. To be familiar with the treatment of chronic prostatitis Teaching Benign prostatic hyperplasia, assessment of the patient with lower urinary tract symptoms, management of men with benign prostatic hyperplasia or bladder outflow obstruction, carcinoma of the prostate and prostatitis Self-learning Surgical anatomy and physiology, and seminal vesicles

Chapter 64. THE URETHRA AND PENIS Learning Objectives 1. To recognise the common congenital abnormalities of the urethra 2. To master the pathology, diagnosis, and emergency management of urethral trauma and understand the management of the urethra stricture 3. To be familiar with the clinical features diagnosis and management of the carcinoma of the penis and understand the principles of their surgical management Teaching Injuries of male urethra and carcinoma of the penis Self-learning Congenital abnormalities, urethral infections, urethral stricture, and urethral calculi 301

Chapter 65. TESTIS AND SCROTUM Self-learning 1. To know the main types of imperfect testicular descent and the main indications for surgical intervention 2. To understand why testicular torsion is a urological emergency 3. To know the principles of surgical management of varicocele, hydrocele and cystic swellings associated with the testis and epididymis 4. To know a classification and understand the principles of management of testicular tumours 5. To understand the options available to treat infertile men Learning Objectives Development of the testis, incompletely descended testis, hydrocele, vericocele, epididymo-orchitis, and tumours of the testes

Chapter 66. ARTERIAL DISORDERS Learning Objectives 1. To understand the nature of occlusive arterial disease, and its associated symptoms and signs 2. To use these symptoms and signs to achieve a site-specific diagnosis 3. To appreciate the vascular laboratory and radiological techniques that may assist diagnosis 4. To be aware of possible treatment options: medical, radiological, surgical 5. To be familiar with the nature of acute arterial occlusion, especially embolism and trauma 6. To be able to assess acute arterial occlusion and know the treatment options 7. To understand the principles of management of the severely ischaemic limb, including gangrene 8. To be aware of the various levels of amputation 9. To master the nature of aneurysmal disease and its associated symptoms and signs 10. To have particular knowledge of the presentation of abdominal aortic aneurysm 11. To appreciate the investigative techniques relevant to aneurysmal dilatation 12. To be aware of treatment options for aneurysm: surveillance, open surgery, endovascular surgery 13. To have basic knowledge of the arteritides and vasospastic disorders that may present to the vascular surgeon 302

Teaching Symptoms and signs of lower limb arterial stenosis or occlusion, acute occlusion, aneurysm (general), and Raynaud syndrome Self-learning Investigation of arterial stenosis or occlusion, transluminal angioplasty and stenting, operations for arterial stenosis or occlusion, and amputation Observation & Pactice To have a case presentation by video disc of lower limb ischemia, including laboratory parameters, X-ray films, CT film and pathology.

Chapter 67. VENOUS DISORDERS Learning Objectives 1. To be familiar with the venous anatomy of the lower limb 2. To understand the physiology of venous return 3. To be masterymaster of varicose veins and their clinical significance 4. To have knowledge of deep venous thrombosis 5. To have knowledge of venous insufficiency and ulcers Teaching Venous pathophysiology, varicose vein, deep vein incompetence, and deep venous thrombosis Self-learning Leg ulcer Observation & Pactice To have a case presentation by video disc of varicose vein, and deep venous thrombosis, including laboratory parameters, X-ray films, CT film and pathology.

Chapter 68. LYMPHOEDEMA Learning Objectives 1. To be able to list the main functions of the lymphatic system 2. To be able to describe how the lymphatic system develops 3. To be able to differentiate the various causes of a swollen limb on the basis of history, examination and results of investigations 4. To be able to define the term lymphoedema and describe how it develops 303

5. To be able to classify lymphoedema on the basis of clinical presentation, underlying aetiology and the results of investigations 6. To be able to describe the physical, pharmacological and surgical treatments for lymphoedema

Volume 5. Abdominal and Pediatric Surgery Chapter 69. STOMACH AND DUODENUM Learning Objectives 1. To understand the gross and microscopic anatomy and pathophysiology of the stomach in relation to disease 2. To be able to decide on the most appropriate techniques to use in the investigation of patients with complaints relating to the stomach and duodenum 3. To understand the critical importance of gastritis and Helicobacter pylori in upper gastrointestinal disease 4. To be able to investigate and treat peptic ulcer disease and its complications 5. To be familiar with the clinical features of peptic ulcer disease 6. To master the indications and sequelae of surgical treatment, and how to select the appropriate procedure 7. To be familiar with the clinical features, diagnosis and treatment of perforated peptic ulcer, bleeding peptic ulcer, and gastric outlet obstruction 8. To be able to recognise the presentation of gastric cancer and understand the principles involved in its treatment 9. To know about the causes of duodenal obstruction and the presentation of duodenal tumours Teaching Gastritis, surgical indications and complications for peptic ulcer, perforated peptic ulcer, bleeding peptic ulcer, gastric outlet obstruction and gastric cancer (lymphatic drainage of the stomach, operability, and postoperative complications of gastrectomy) Self-learning The gross and microscopic anatomy and pathophysiology of the stomach and the investigation of patients with complaints relating to the stomach and duodenum, gastric stromal tumours, gastric lymphoma, duodenal tumours, and gastric operations for morbid obesity Observation & Pactice 304

1. Clinical case analysis: to have a case presentation of gastric and duodenal ulcer, and gastric cancer, including laboratory parameters, X-ray films, endoscopic photos and pathology. 2. Surgery demonstration of subtotal gastrectomy by video disc, especially for malignant disease.

Chapter 70. THE LIVER Learning Objectives 1. To understand the anatomy of the liver 2. To recognise signs of acute and chronic liver disease 3. To request appropriate investigations 4. To understand the management of liver trauma, infections, cirrhosis and turnouts 5. To master the diagnosis and management of bleeding varices 6. To understand the causes, diagnosis, differential diagnosis and treatment of pyogenic liver abscess 7. To be familiar with the diagnosis, differential diagnosis and treatment of liver cancer Teaching Liver function and tests, liver trauma, portal hypertension, chronic liver conditions, pyogenic liver abscess, amoebic liver abscess, and liver tumours Self-learning Anatomy of the liver, acute and chronic liver diseases, liver imaging, Budd-Chiari syndrome, and hydatid liver disease Observation & Pactice 1. Clinical case analysis: to have a case presentation of portal hypertension, and hepatic cancer, including laboratory parameters, X-ray films, CT film and pathology. 2. Sengstaken-Blakemore tube insertion demonstration by video disc.

Chapter 71. THE SPLEEN Learning Objectives 1. To have on understanding of the common pathologies involving the spleen 2. To understand the principles of splenectomy and its potential complications 3. To understand the indications for and the potential advantages of laparoscopic splenectomy 4. To appreciate the consequences of splenectomy and the importance of prophylaxis against 305

infection following splenectomy Teaching Splenic rupture, splenomegaly and hypersplenism, and splenectomy Self-learning Embryology, anatomy, physiology, function and investigation of the spleen, liver imaging, Budd-Chiari syndrome, and hydatid liver disease

Chapter 72. THE GALL BLADDER AND BILE DUCTS Learning Objectives 1. To understand the techniques used for imaging the biliary tree 2. To master the clinical features, diagnosis and management of gallstones, acute cholecystitis, stones in the bile duct, and acute obstructive suppurative cholangitis 3. To be aware of unusual disorders of the biliary tree 4. To be aware of malignant disease of the biliary tree Teaching Investigation of the biliary tract, choledochal cyst, gallstones (causal factors in gallstone formation, pigment stones, complications, cholecystitis and cholecystectomy), management of bile duct obstruction (acute obstructive suppurative cholangitis), stricture of the bile duct, biliary ascariasis, and tumours of the bile duct Self-learning Surgical anatomy and physiology of the biliary tract, congenital abnormalities of the gall bladder and bile ducts, extrahepatic biliary atresia, and primary sclerosing cholangitis Observation & Pactice Clinical case analysis: to have a case presentation of cholelithiasis or acute cholecystitis, including laboratory parameters, ultrasonography, CT film and pathology.

Chapter 73. THE PANCREAS Learning Objectives 1. To understand the anatomy and physiology of the pancreas 2. To be familiar with investigation of the pancreas 3. To be aware of the rarer conditions of the pancreas 4. To be familiar with the assessment and management of a patient with acute pancreatitis 306

5. To master pancreatic cancer--its diagnosis, treatment and palliation Teaching Injuries to the pancreas, pancreatitis, carcinoma of the pancreas, and endocrine tumours of the pancreas Self-learning Surgical anatomy and physiology of the pancreas, investigations of the pancreas, and chronic pancreatitis Observation & Pactice Clinical case analysis: to have a case presentation of obstructive jaundice or acute pancreatitis, including laboratory parameters, ultrasonography, CT film and pathology.

Chapter 74. THE PERITONEUM, OMENTUM, MESENTERY AND RETROPERITONEAL SPACE Learning Objectives 1. To master the clinical features and diagnosis of acute peritonitis 2. To know the common causes and complications of peritonitis (abscess) 3. To understand the principles of surgical management in patients with peritonitis 4. To know the clinical presentations and treatment of abdominal/pelvic abscesses 5. To know the clinical presentations of tuberculous peritonitis 6. To understand the causes and pathophysiology of ascites 7. To recognise the spectrum of mesenteric and retroperitoneal conditions Teaching Acute peritonitis, special forms of peritonitis, tuberculous peritonitis and ascities Self-learning the peritoneum, and neoplasmas of the peritoneum Observation & Pactice Clinical case analysis: to have a case presentation of acute peritonitis, including laboratory parameters, ultrasonography, CT film and pathology.

Chapter 75. THE SMALL AND LARGE INTESTINES Learning Objectives 1. To know that embryologically the gut is a midline structure with a bilateral nerve supply and 307

true visceral pain is referred to the midline 2. To know that peritoneal pain is somatic, more precise, more severe and localised to the site of origin 3. To be able to distinguish irrefutably small from large bowel, jejunum from ileum and the proximal from the distal end of any loop under consideration 4. To know that taenia coli and appendices epiploicae characterise the large intestine. To know that the mesentery of the jejunum has only two series of arcades of blood vessels, while the lower ileum has several series. To know that the mesenteric attachment of the small bowel runs from the mesenteric attachment in the upper left of the abdomen to the lower right 5. To be able to recognise, investigate appropriately and treat the range of conditions that may affect the small and large intestines that are detailed below 6. To know that the surgical management of small and large intestinal disease is best conducted with a multidisciplinary team 7. To be familiar with the clinical features, diagnosis and management of malignant tumours of large intestine Teaching Ulcerative colitis, Crohn disease, and tumours of large intestine Self-learning Megacolon and non-megacolon constipation, diverticular disease, vascular anomalies, and benign tumours of large intestine

Chapter 76. INTESTINAL OBSTRUCTION Learning Objectives 1. To master the pathophysiology of dynamic and adynamic intestinal obstruction. 2. To master the cardinal features on history and examination, diagnosis and principles of management of dynamic intestinal obstruction 3. To understand the causes of small and large bowel obstruction 4. To understand the indications and contraindications for conservative management in bowel obstruction Teaching Acute intestinal obstruction, treatment of acute intestinal obstruction, and volvulus Self-learning 308

Acute intestinal obstruction of the newborn, chronic intestinal obstruction and adynamic obstruction Observation & Pactice Clinical case analysis: to have a case presentation of acute intestinal obstruction, including laboratory parameters, CT film and pathology.

Chapter 77. THE VERMIFORM APPENDIX Learning Objectives 1. To understand the aetiology and pathology of acute appendicitis 2. To master the clinical signs, differential diagnoses and treatment of acute appendicitis 3. To review basic surgical techniques, both open and laparoscopic 4. To be familiar with the complications of acute appendicitis and postoperative complications 5. To identify less common conditions occasionally encountered Teaching Anatomy, acute appendicitis and less common pathophysiological conditions Observation & Pactice 1. Clinical case analysis: to have a case presentation of acute abdomen, including laboratory parameters, CT film and pathology. 2. Surgery demonstration of appendectomy by video disc

Chapter 78. THE RECTUM Learning Objectives 1. To understand the anatomy of the rectum and its relationship to surgical disease and its treatment 2. To understand the pathology, clinical presentation, investigation, differential diagnosis and treatment of diseases that affect the rectum 3. To be familiar with the clinical feature, diagnosis and treatment of the rectal cancer. 4. To appreciate that the symptoms of rectal cancer are similar to benign disease, and hence patients with such symptoms must be carefully evaluated 5. To master the diagnosis and treatment of the rectal prolapse Teaching the anatomy of the rectum, clinical features of rectal disease, rectal prolapse, benign tumours, 309

rectal cancer Self-learning Rectal injuries, foreign bodies in the rectum, proctitis, solitary rectal ulcer, Observation & Pactice 1. Clinical case analysis: to have a case presentation of rectal cancer, including laboratory parameters, CT film and pathology. 2. Surgery demonstration of radical resection of rectal cancer by video disc

Chapter 79. THE ANUS AND ANAL CANAL Learning Objectives 1. To understand the anatomy of the anus and anal canal and their relationship to surgical disease and its treatment 2. To understand the pathology, clinical presentation, investigation, differential diagnosis and treatment of diseases which affect the anus and anal canal 3. To appreciate that anal disease is common and its treatment tends to be conservative, although surgery may be required 4. To understand that too aggressive or inappropriate surgery may render the patient permanently disabled 5. To master the diagnosis and treatment of anal fissure, haemorrhoids, anorectal abscesses, and fistula in ano Teaching the anatomy of the the anus and anal canal, examinations of the anus, anal fissure, haemorrhoids, anorectal abscesses, and fistula in ano Self-learning Congenital abnormalities, anal incontinence, pruritus ani, and malignant tumours Observation & Pactice Demonstration of investigation the anus and anal canal by video disc

Chapter 80. HERNIAS, UMBILICUS AND ABDOMINAL WALL Learning Objectives 1. To appreciate that hernias can strangulate, and then become surgical emergencies 2. To know that femoral hernias are especially susceptible to strangulation 310

3. To understand the anatomy of the common hernias, including inguinal canal, Hesselbach triangle, and femoral canal 4. To be familiar with the common surgical approaches to hernias, the principles of inguinal hernia repair and the management principles of incarcerated or strangulated hernias. 5. To master the differential diagnosis of indirect hernia from direct hernia 6. To know the common surgical approaches to hernias Teaching Hernia, burst abdomen and incisional hernia Self-learning Umbilicus Observation & Pactice 1. Clinical case analysis: to have a case presentation of inguinal hernia or incisional hernia, including laboratory parameters, CT film and pathology. 2. Surgery demonstration of inguinal hernia repair by video disc (open without mesh, open with mesh, and laparoscopic with mesh)

Chapter 81. PRINCIPLES OF PAEDIATRIC SURGERY Learning Objectives 1. To acquire a working knowledge of relevant anatomical, physiological and psychological differences between adults and children 2. To know the structured approach to managing children with major trauma 3. To understand the pathology and the principles of management of common paediatric surgical conditions 4. To be aware of the spectrum of congenital malformations relevant to general surgery

Course 2. Integrated Curriculum of Clinical Medicine -- Surgery Chapter 1. Advances in basic surgery Learning Objectives 1. To recognize the advances of basic surgery 2. To know the basic principles of damage control surgery 3. To understand the progress of the techniques involved in CPR and emergency surgery

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Chapter 2. Advances in surgical oncology Learning Objectives 1. To recognize the development process of surgical oncology 2. To know the principles and aim of surgical oncology 3. To know the multidiscipline therapy of cancer and the role of surgery in multidiscipline therapy 4. To understand the principles of no-tumor technique

Chapter 3. Introduction and advances in minimally invasive surgery Learning Objectives 1. To recognize the development process of minimally invasive surgery 2. To know the application area of minimally invasive surgery 3. To understand the basic principles and techniques of minimally invasive surgery

Chapter 4. Advances in general surgery Learning Objectives 1. To recognize the advances of general surgery, especially gastrointestinal and heptic-billiary surgery 2. To know the progress of colorectal surgery and multidiscipline therapy of colorectal cancer 3. To know the progress of hepatic surgery 4. To understand the advanced techniques involved in acute abdomen

Chapter 5. Advances in orthopedic surgery Learning Objectives 1. To recognize the advances of orthopedic surgery 2. To know the progress of bone fracture and spine surgery 3. To understand the advanced techniques involved in first aid for trauma

Chapter 6. Advances in Urology Learning Objectives 1. To recognize the advances of urology 2. To know the application of minimally invasive surgery in urology 312

3. To understand the advanced techniques involved in lithangiuria

Chapter 7. Advances in cardiothoracic surgery Learning Objectives 1. To recognize the advances of cardiothoracic surgery 2. To know the application of novel surgical techniques for congenital heart disease 3. To understand the advanced techniques involved in lung cancer surgery

Chapter 8. Advances in plastic surgery Learning Objectives 1. To recognize the advances of plastic surgery 2. To know the application of novel surgical techniques for plastic surgery 3. To understand the principles and management of burning

Chapter 9. Advances in neurosurgery Learning Objectives 1. To recognize the advances of plastic surgery 2. To know the application of novel surgical techniques for cerebral tumor 3. To understand the principles and management of cerebral hemorrhage

Ⅲ. Practice Requirements 1. Clearly distinguishing among hygiene, sterile, nonsterile, and aseptic. Mastering the rationale for practicing surgical aseptic technique and practice the rules of aseptic technique, including the surgical hand scrub, donning gown and gloves, skin preparation and draping. 2. Correctly master the estimating skills such as accessing airways or taking accurate pulse checks. Master the skills of basic life support (BLS) by practicing the techniques on CPR simulator, mouth-to-mouth ventilation and external chest compression. 3. Surgery belongs to practice or experience based science. During the period of rotation the student should implement, enhance and broaden the medical knowledge previously acquired to convey the knowledge of how to diagnose and treat surgical illnesses and familiarize medical learners with the corresponding anatomical structures and disease etiology, progression, pathology, diagnosis, prevention and treatment. This means that the student 313

should maintain close contacted with patients and help decide on proper medical treatment for each case.

Ⅳ. Competence Training Requirements 1. Analytic competence: Seminars on special topics will be hold during the observation & practice programs, in which clinical data (or patient), laboratory parameters, and X-ray films will be offered, students are expected to present their opinions to diagnose and treat surgical illnesses and discuss interactively with their program director. Rotation students (interns) must attend clinical pathological conference (CPC), and preoperative conference and, are encouraged to express their own diagnosis or treatment opinions or discuss with their supervisor. 2. Students are encouraged to improve their diagnosing and treatment skills and competencies through operation video disc watching, interactive teaching session, patient presentation, history-taking, clinical examination-performing, X-ray film-reading, surgical skills, differential diagnosis, and clinical decision-making. 3. Competence of interpersonal and communication skills: During the three months of rotation in surgery in their clerkship year students must follow their supervisor to participate in the daily surgical activities in the hospital and learn how to communicate with patients and their families. After successful completion of the Surgery Curriculum, interns will exhibit superior and appropriate teamwork behavior in the context of the patient care team, interacting professionally with other members of the patient care team in order to provide optimal patient care. 4. Self-learning competence training: The course goal is to promote the continuing professional development of medical students through leading-edge educational programs and products that address the acquisition and maintenance of competencies. During the surgery rotation students are required to search the pertinent literature and to accompany report. 5. The Surgery Education is committed to supporting continuous professional development of individuals through a range of educational activities including seminars, teaching round, surgical lectures for interns, preoperative conferences, meetings, and educational programs in hospital. It intends to comprehensively evaluate the impact of educational interventions on students' learning and behaviors and patient outcomes through a process of continuous quality improvement. 314

6. Expression competence training: During seminars students are encouraged to present their report or opinions for each case to their colleagues. 7. Innovation (creative, initiative) competence training: The Department of Surgery also promotes the field of surgical research. Therefore students can assist in basic research and in development new diagnostic and therapeutic techniques.

Ⅴ. Hours Distribution Course 1. Surgery: Volume 1. Basic Surgery Chapter Content Lecture Practice 1 Introduction 2 Diagnostic and interventional radiology 1 3 Preparing a patient for surgery 1 4 Anaesthesia and pain management 9 17 Day surgery 1 Acute life support and critical care: fluid, electrolyte 5 and acid-base balance and blood transfusion 6

6 Nutrition 1.5 20 Surgical ethics 0.5 8 Basic surgical skills and anastomoses 40 9 Principles of laparoscopic surgery 10 Wound infection 1.5 Appendix Tetanus 0.5 11 Sterile precautions and theatre safety 12 Parasitic infections 7 Wounds, tissue repair and scars 0.5 15 Cysts, ulcers and sinuses 0.5 21 Plastic and reconstructive surgery 1 14 Transplantation 2 16 Principles of oncology 2 18 An approach to surgical audit

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19 Clinical trials and statistics 22 Burns 2 4 23 Accident and emergency surgery 2 24 Warfare injuries 1 13 Acquired immunodeficiency syndrome 1 25 Postoperative care 2

Volume 2. Orthopedics Chapter Content Lecture Practice 26 Clinical examination in musculoskeletal disorders 27 Musculoskeletal imaging 28 Fractures and dislocations 4 12 29 Problems in the shoulder and elbow 4 30 Pelvic and acetabular fractures 1 31 Lower limb trauma 1 32 Surgery for arthritis in the hip and knee 2 33 Diseases of bones and joints: infection 2 34 Bone tumours 2 35 Diseases of the bones, joints and connective tissues 1 Paediatric orthopaedics: normal development and 36 1 congenital disorders 37 Paediatric orthopaedics: diseases of the growing skeleton 4 38 Sports medicine and biomechanics 1 39 Wrist and hand 3 40 The foot 41 Neurological disorders and the musculoskeletal system 42 The spine, vertebral column and spinal cord 4

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Volume 3. Otorhinolaryngology, Head and Neck, Cardiothoracic and Endocrine Surgery Chapter Content Lecture Practice 43 The eye and orbit Cleft lip and palate: developmental abnormalities of 44 the face, mouth and jaws 45 Maxillofacial injuries 46 The nose and sinuses 47 The ear 48 Oral and oropharyngeal cancer 49 Disorders of the salivary glands 50 Pharynx, larynx and neck 51 The thyroid gland and the thyroglossal tract 1.5 52 Parathyroid and adrenal glands 0.5 53 The breast 2 54 The thorax 6 4 55 Cardiac surgery 2 56 The oesophagus 2

Volume 4. Neurosurgery, Urinary and Vascular Surgery Chapter Content Lecture Practice 57 Nerves 58 Craniocerebral trauma 4 4 59 Elective neurosurgery 2 Urinary symptoms, investigation of the urinary tract 60 and anuria 61 The kidneys and ureters 4 62 The urinary bladder 3 63 The prostate and seminal vesicles 3 64 The urethra and penis 2 65 Testis and scrotum

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66 Arterial disorders 2 67 Venous disorders 2 68 Lymphoedema

Volume 5. Abdominal and Pediatric Surgery Chapter Content Lecture Practice 69 Stomach and duodenum 4 16 70 The liver 3 71 The spleen 2 72 The gallbladder and bile ducts 3 73 The pancreas 2 The peritoneum, omentum, mesentery and 74 2 retroperitoneal space 75 The small and large intestines 3 76 Intestinal obstruction 2 77 The vermiform appendix 2 78 The rectum 2 79 The anus and anal canal 2 80 Hernias, umbilicus and abdominal wall 3 81 Principles of paediatric surgery

Summary class hour assignment Contents Lecture hour Practice Basic Surgery 36 44 (including 40 hrs for BSS training) General Surgery 38 16 Orthopedics 30 12 Urinary Surgery 12 4 Cardiothoracic Surgery 10 4 Neurosurgery 6 4 132 84

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Course 2. Integrated curriculum of clinical medicine -- Surgery

Chapter Content Lecture Practice

1 Advances in basic surgery 6

2 Advances in surgical oncology 4

3 Introduction and advances in minimally invasive surgery 4 4

4 Advances in general surgery 6 4

5 Advances in orthopedic surgery 4 4

6 Advances in Urology 2 2

7 Advances in cardiothoracic surgery 2 2

8 Advances in plastic surgery 2

9 Advances in neurosurgery 2

Summary 32 16

Total: 264 class hours. Each session of practice takes 4 class hours (4 hours per session, six sessions each lasting 4 hours).

Ⅵ. About the Examinations Surgical education usually switches on at the 4th academic year of medical students in University, lasts two semesters, and four examinations will be administered each in the middle term and at the end of the semester. Written test usually consists of following sections, multiple choice questions, medical terminology definition (interpretation), and question & answer or clinical case analysis. 1. The first semester completion examination will involve Basic Surgery, Neurosurgery and Cardiothoracic surgery. The basic surgical skill will make up 30％ of total score, middle-term written test 30%, and final written test 40％ of it. Middle-term test questions come from chapters 1-20. Prior to applying to the semester final written test, all students should pass the basic surgical skill. 2. The second semester completion examination will involve Urology Surgery, General Surgery

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and Orthopedic Surgery. Two written tests will be administered in the middle and at the end of this semester. 3. Graduation examination is administer after complete the final of clinical work, which will involve all parts in the textbook, especially urology, general surgery and orthopedics. Clinical case analysis will account to 20 per cent of total score.

Ⅶ.Textbooks & Selected Reference Books 1. Russell RCG., Williams NS., Bulstrode CJ K.. Bailey & Love SHORT PRACTICE OF SURGERY. 24th edition. People’s Medical Publishing House, Beijing. 2006 2. Tang WH, Wu Xiao. Introduction to Basic Surgical Skill (Bilingual edition). Science Press, 1st edition. Beijing. 2007 3. Townsend CM Jr. Sabiston Textbook of Surgery, 19h ed. Elsevier Saunders, Philadelphia. 2012 4. Gerard Doherty. Current Surgical Diagnosis & Treatment, 13th ed. The McGraw-Hill Companies, Inc. 2010 5. Way LW. Current Surgical Diagnosis & Treatment, 12th ed. Appleon & Lange. 2007

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Internal Medicine

Credits: 10 Total hours: 184 Lectures hours: 136 Experiment hours 48 Grade: 4th,5th Semester: 2,1 Mei-Mei Wang Compilers: Lin-Li Lv Email: [email protected]

Preface The purpose of this course is to provide training in the discipline of internal medicine. The objective is to provide exposure to pathophysiology, diagnostic and treatment methods used in this field. It focuses on diagnostic decision making, case presentation skills, history and physical skills, therapeutic decision making, communication skills, and professionalism. Bedside lecture, bedside teaching is very important to the learning experience. Student will be able to take an extended history and physical exam from a patient and be able to learn the specific disease from the real case. The Syllabus describes in details, expectations from trainees what should be mastered and understood upon completion of training. All topics covered during practical and theoretical study are outlined. This will help trainees to guide their readings and their choice of learning activities. In additions, schedules of teaching and learning are outlined. Methods of assessment and examination regulations are also available in the last section of the Syllabus. We hope that all our trainees, trainers and educational supervisors will follow the guidesguide provided in the Syllabus and cooperate with the Academic Affairs Office of Medical School and Internal Medicine Office to implement the curriculum in the best ways.

Ⅰ. Preamble and Objectives： Internal medicine is a discipline encompassing the study and practice of health promotion, prevention, diagnosis and treatment of disease. It focuses on both the development of clinical skills and the acquisition of theoretical knowledge of important diseases encountered by internists. Students will be trained to solve clinical problem with full responsibility and compassion to

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patients. Upon completion of the course, students are expected to understand the pathological mechanism, clinical features, diagnosis and management of common medical conditions and to master the basic skills in clinic practice.

Ⅱ. Contents and Requirements： Section 1. Respiratory system Introduction To be familiar with To be familiar with anatomical features of the respiratory system, to understand the etiology, clinical manifestations of pulmonary disease and the new diagnostic methods.

Chapter 1. Chronic obstructive pulmonary disease(COPD) To master 1. To master the definition, clinical manifestations, the lab test and the diagnosis; 2. To master the influence of environmental and personal factors on the occurrence and development and the pathological changes; To understand To understand COPD is a common disease with high incidence and serious complication which should be treated aggressively.

Chapter 2. Pulmonary hypertension and pulmonary heart disease： To master 1. To master the clinical characteristics and diagnosis at both remission and acute exacerbations phase; 2. to master the treatment of respiratory insufficiency and cardiac dysfunction in conditions of pulmonary heart disease; 3. to master the strategies for prevention and treatment in remission period; to understand the pathogenesis of pulmonary hypertension, acid-base and electrolyte imbalance in chronic pulmonary heart disease; To be familiar with To be familiar with the prevention of the disease. To understand 322

To understand that chronic pulmonary heart disease is a systemic disease on the basis of pulmonary dysfunction characterized by complexity;

Chapter 3. Bronchial asthma To master 1. To master the treatment of severe asthma. 2. To be able to use anti-asthmatic drug, especially anti-inflammatory drug and beta2 receptor agonists; To be familiar with To familiar with the pathogenesis, symptoms, types, diagnosis and differential diagnosis, complications;

Chapter 4. Respiratory failure To master 1. to master the etiology, pathogenesis and pathophysiology; 2. to master the significance of arterial blood gas analysis, acid-base and electrolyte imbalance; 3. to master the symptoms and treatment principles of chronic respiratory failure.

Chapter 5. Pneumonia: To master To master the pathology and clinical manifestations of pneumococcal pneumonia, the definition of community-acquired pneumonia and hospital-acquired pneumonia; To be familiar with To familiar with the pathology, clinical features, diagnosis and treatment of Staphylococcal pneumonia, Klebsiella pneumoniae and Mycoplasma pneumoniae.

Chapter 6. Tuberculosis: To master To mater the development of tuberculosis and its connections with allergy and immunity, the diagnosis and differential diagnosis, the proper usage of anti-tuberculosis drugs and the managment of massive hemoptysis; To be familiar with 323

To be familiar with the characteristics of X-ray and the relationship with the pathology; To be familiar with methods of sputum examination for tubercle bacillus; principles for prevention, methods of Tuberculin skin test and BCG vaccination.

Chapter 7. Primary bronchogenic carcinoma: To master To master the early symptoms, early diagnosis and principles of management; To be familiar with To be familiar with the pathological characteristics.

Chapter 8. Pleural disease: To master 1. To master the diagnosis and differential diagnosis; 2. To master the key points for discriminate in differentiating the benign andfrom malignant pleural fluid, the transudative and exudative pleural effusions; To be familiar with 1. to be familiar with the pathogenesis and etiology of pleural effusion; 2. to be familiar with the prevention and treatment of tuberculous pleurisy; 3. to be familiar with the classification, sypmtoms, differential diagnosis and X-ray characteristic of pneumothorax; to understand the definition, etiology and pathogenesis of pneumothorax; To understand To understand the principles of treatment of empyema.

Section 2. Cardiovascular System Introduction To be familiar with To be familiar with the common symptoms of circulatory system diseases, physical signs and common methods for diagnosis and treatment; To understand To understand the new progress in research of this field.

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Chapter 1. Heart failure： To master To master the etiology, pathophysiology, diagnosis, differential diagnosis and treatment principles of cardiac dysfunction, especially the proper use of digitalis, diuretics and vasodilators, as well as rescue method of acute left ventricular failure.

Chapter 2. Arrhythmia: To master To master the common cause, symptoms, and diagnosis and therapy principles of arrhythmia; To be familiar with To be familiar with the ECG characteristics of common arrhythmia; To understand To understand the pathogenesis of arrhythmia.

Chapter 3. Hypertension: To master To master the diagnosis, differential diagnosis and treatment; To be familiar with To be familiar with the classification, risk stratification; To understand To understand the pathogenesis and the development process.

Chapter 4. Artery Atherosclerosis and Coronary Atherosclerotic Heart Disease: To master 1. To master the risk factors, the pathogenesis and development; 2. To master the symptoms, diagnosis, differential diagnosis and management.

Chapter 5. Valvular Disease of The Heart(VDH): To master To master the etiology, pathophysiology, clinical manifestations, diagnosis and differential diagnosis of the common VDH; To be familiar with 325

1. To be familiar with the relationship between rheumatic valvular disease with the activity of rheumatoid disease, 2. To be familiar with its complications, treatment principles and indications for surgery; To understand To understand the incidence trend and the lab test for valvular disease.

Chapter 6. Myocardial diseases: To master To master the diagnosis and treatment principles of cardiomyopathy; To be familiar with To bemfamiliar with the etiology, diagnosis, and treatment principles of myocarditis; To understand To understand the classification of cardiomyopathy and myocarditis.

Chapter7. Pericardial disease: To master To master the clinical manifestations, diagnosis and treatment principles of pericarditis; To understand To understand the types, etiology and pathology of all pericarditis types.

Chapter 8. Interventional therapy of cardiovascular disease: To be familiar with 1. To be familiar with the composition, types and indications of the artificial heart pacemakers ; 2. To be familiar with radio frequency ablation for bypass, atrioventricular nodal reentrant, atrial tachycardia, ventricular tachycardia ; 3. To be familiar with indications of percutaneous transluminal coronary for angioplasty, 4. To be familiar with indications of percutaneous transluminal coronary stent implantation; To understand 1. To understand mechanism of cardiac pacing, pacing mode and multi-site pacing, understand the indications for implantable cardioverter defibrillator, the radiofrequency ablation for atrial flutter, atrial fibrillation; 2. To understand the mechanism, indications and contraindications of spin atherectomy and 326

atherectomy; 3. To understand the interventional treatment of valvular heart disease and congenital heart disease.

Section 3. Digestive Diseases Introduction: To master To master the similarities and different of symptoms for of digestive diseases and commonly used diagnostic method; To be familiar with To be familiar with the connections of digestive structure features with disease; To understand To understand the new developments of thein diagnosis and treatment of digestive diseases of digestive diseases.

Chapter 1. Gastritis: To master To master the symptoms, diagnosis and differential diagnosis; To understand 1. To understand that Gastritis is a common disease; 2. To understand the principles for treatment and prevention.

Chapter 2. Peptic Ulcer: To master To master the symptoms, diagnosis and differential diagnosis; To be familiar with To be familiar with the principles forof treatment and prevention; To understand To understand the etiology and pathogenesis.

Chapter 3. Gastric Cancer: To master 327

To master the symptoms, early diagnosis and precancerous lesions; To be familiar with To be familiar with the pathology; To understand To understand the therapeutic principles.

Chapter 4. Intestinal Tuberculosis and Tuberculous Peritonitis: To master To master the sypmtoms and diagnosis of intestinal tuberculosis and tuberculous peritonitis; To be familiar with To be familiar with the complications and treatment

Chapter 5. Inflammatory Bowel Disease To master To master the symptoms and diagnosis of ulcerative colitis and Crohn's disease; To be familiar with To be familiar with the differential diagnosis, complications, treatment and laboratory and other tests of ulcerative colitis and Crohn's disease; To understand To understand the etiology and pathogenesis, pathology and prognosis.

Chapter 6. Cirrhosis To master To master the symptoms and diagnosis of door venous cirrhosis; To be familiar with To be familiar with the differential diagnosis and complications; To understand To understand the etiology and pathogenesis and management principles.

Chapter 7. Primary liver cancer To master To master the symptoms and key points for diagnosis; 328

To understand 1. to understand the disease is common in china; 2. to understand the importance of early diagnosis and differential diagnosis.

Chapter 8. Hepatic encephalopathy To master To master the clinical manifestations, diagnosis and differential diagnosis of hepatic coma; To understand To understand the etiology, pathogenesis and methods for prevention and management.

Chapter 9. Acute pancreatitis To master To master the key points for clinic manifestation and diagnosis; to mater the methods for prevention and treatment. To understand To understand the development process of the disease;

Chapter 10. Upper gastrointestinal bleeding To master 1. To master the four most common cause; 2. To master the identification, the determination of the bleeding amount and the possibility for continued bleeding; 3. To master the therapeutic principles.

Section 4. Urinary system disease Introduction To master To master the common symptoms, the common lab test and diagnosis methods and the management principles of urinary system disease; To be familiar with To familiar with the structure and physiological function of the kidney; To understand 329

To understand the connection between urinary system and the other system and the modern development in this field.

Chapter 1. Primary glomerular disease To master 1. To master the symptoms and lab test of rapidly progressive glomerulonephritis; 2. To master the symptoms, diagnosis and differential diagnosis of chronic glomerulonephritis; To be familiar with 1. To be familiar with the definition, pathogenesis and the classification of clinical pathology; to master the symptoms of glomerular disease; 2. To be familiar with the mechanism of proteinuria, hematuria, edema, hypertension and renal function damage; 3. To be familiar with the definition, cause, pathogenesis and pathology of rapidly progressive glomerulonephritis; 4. To be familiar with the definition, cause, pathogenesis and pathology of chronic glomerulonephritis; To understand 1. To understand the diagnosis, differential diagnosis and intensive treatment; 2. To understand the treatment of chronic glomerulonephritis.

Chapter 2. Nephrotic syndrome To master To master the pathological classification, clinical manifestations, differential diagnosis and treatment. To be familiar with To be familiar with definitions and pathophysiology;

Chapter 3. Urinary tract infection To master To master the symptoms, diagnosis and treatment principles. To be familiar with To be familiar with the pathogenesis; 330

To understand To understand the cause of repeated episodes of chronic pyelonephritis;

Chapter 4. Acute kidney injury To master To master the definition, symptoms and diagnosis; To be familiar with To be familiar with the treatment of acute renal failure. To understand To understand the etiology and pathogenesis of acute renal failure;

Chapter 5. Chronic renal failure: To master To master the stage, clinical manifestations and diagnosis. To understand To understand the treatment of chronic renal failure

Chapter 6. Blood Purification Therapy To master To master the mechanism, indications, complications, and management; To be familiar with 1. To be familiar with the definition of blood purification therapy and related technology; 2. To be familiar with the hemodialysis vascular access, anticoagulation method and dialysis adequacy; To understand 1. To understand the mechanism of water and solute clearance; 2. To understand the composition and type of dialyzer.

Section 5. Hematopoietic System Diseases Introduction and anemia overview: To master 1. To master the basic concepts of anemia, the importance forof identifying the cause of anemia, 331

the diagnostic steps and methods; 2. To master the pathogenesis, classification and treatment principles. To be familiar with To befamiliar with the generation of blood cells and its development and regulation; To understand To understand the scope, classification, common symptoms and signs of hematopoietic system diseases, laboratory tests , prevention and treatment progress;

Chapter 1. Iron deficiency anemia: To master 1. To master the cause forof iron deficiency, the symptoms and the lab tests; 2. To master the diagnosis and treatment; To understand To understand the incidence and iron metabolism.

Chapter 2. Aplastic anemia: To master To master of the etiology, clinical manifestations and hematological characteristics, diagnosis, differential diagnosis and treatment; To understand To understand the incidence, pathogenesis, pathological changes, and prognosis.

Chapter 3. Warm antibody autoimmune hemolytic anemia: To master To master the classification, symptoms, lab examination, diagnosis and differential diagnosis; To be familiar with To be familiar with the treatment principles.

Chapter 4. Myelodysplastic syndrome: To master To master the classification, lab examination and special tests for primary myelodysplastic syndrome; 332

To be familiar with To be familiar with the concept, clinical manifestations, diagnostic methods and treatment principles; To understand To understand the etiology and pathogenesis.

Chapter 5. Leukemia: To master To master the classification, symptoms, lab examination, diagnosis and treatment principles; to understand the modern understanding of the etiology, pathogenesis, the incidence and prognosis.

Chapter 6. Lymphoma: To master To master the classification, diagnosis, stages; To understand To understand the methods for diagnosis and therapeutic principles.

Chapter 7. Plasma Cell Disease: To master To master the pathophysiology and clinical manifestations of multiple myeloma, laboratory tests, diagnostic evidence and treatment; To understand To understand the differential diagnosis and prognosis.

Chapter 8. Thrombocytopenia Purpura: To master To master the symptoms, key points for diagnosis and therapeutic principles for idiopathic thrombocytopenic purpura.

Section 6. Endocrine and Metabolic Diseases Introduction: To master 333

To master the clinics principles and methods for common endocrine disease(meaning not clear)； To be familiar with To be familiar with the physiology and biochemistry of the endocrine system; To understand 1. to understand the content of clinical endocrinology and its clinical importance; 2. to understand the international development of neuroendocrine-immune network.

Chapter 1. Pituitary Hypothyroidism: To master To master the diagnosis, differential diagnosis, and treatment principles. To be familiar with To be familiar with the symptoms, especially the symptoms caused by the dysfunction of the main glands (gonads, thyroid, adrenal); To understand To understand the etiology and pathogenesis;

Chapter 2. Hyperthyroidism: To master To master the principles of medication and anti-thyroid drug side effects; To be familiar with To be familiar with the pathophysiological changes resulting from too much thyroid hormone; to master the symptoms, diagnosis and differential diagnosis, including the special clinical phenomenon; To understand 1. To understand the etiology and pathogenesis; 2. to understand the indications about isotope therapy and surgery and the management principles for hyperthyroidism crisis.

Chapter 3. Thyroid hypofunction: To master To master the symptoms and diagnosis of the cause; To be familiar with 334

To be familiar with the treatment and the rescue principle for myxedema coma To understand To understand the the common causes of this disease.

Chapter 4. Cushing's Syndrome: To master To master the symptoms , diagnosis of the cause and the differential diagnosis with simple obesity; To be familiar with 1. To be familiar with the definition and the common cause; 2. To be familiar with the corresponding treatments for different causes.

Chapter 5. Diabetes: To master 1. To master the clinical manifestations, complications, diagnostic criteria and the comprehensive treatment principles; 2. To master the indication and side effects of insulin and oral hypoglycemic agents; 3. To master the diagnosis and treatment principles of diabetic ketoacidosis. To understand 1. To understand the basic concept and classification; 2. To understand the hypoglycemic treatment progress, and to understand the significance of long-term control of blood glucose;

Section 7. Connective Tissue Disease and Rheumatic Diseases Introduction: To master To master the definition, classification, symptoms characteristics and immunological tests and special examinations for rheumatic diseases; To be familiar with To be familiar with the joint structure, the molecular basis of connective tissue, the immunologic mechanism of rheumatic diseases, medication and diagnosis; To understand To understand the progress in rheumatic diseases. 335

Chapter 1. Rheumatoid Arthritis: To be familiar with To be familiar with the clinical manifestations, diagnosis and differential diagnosis, and treatment principles. To understand To understand the etiology, pathogenesis and pathogenic characteristics of this disease;

Chapter 2. Systemic Lupus Erythematosus: To master To master the symptoms and laboratory tests; To be familiar with To be familiar with the diagnosis, prevention and treatment principles and medications.

Ⅲ.Internal Medicine Clerkship Course Objectives The purpose of clerkship is to provide clinical training in the discipline of internal medicine. It focuses on patient history recording, diagnostic decision making, case presentation skills, history and physical skills, therapeutic decision making, communication skills, and professionalism. The students will participate thein internship, teaching in small groups, and discuss the cases withunder guidance of tutors. The aim wasis to the develop the students' self-learning ability and to be ablethe ability to solve common clinical problems.

Contents and Hours Distribution Number Content Content and requirement Hours To master the pathology, symptoms, diagnosis, differential diagnosis, and treatment principle of 1 Pneumonia 2 pneumococcal pneumonia; to understand the classification of etiology Primary To master the early symptoms, early diagnosis, 2 2 bronchogenic differential diagnosis and treatment principle; to

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carcinoma understand the etiology and pathology characteristics To master the symptoms, diagnosis, the treatment of Chronic obstructive heart and pulmonary insufficiency, the managemnet 3 pulmonary principles for remission stage; to understand the 4 disease-COPD pathogenesis of pulmonary hypertension principle and the mechanism of acid-base and electrolyte imbalance To master the diagnosis, the differentiation between primary and secondary hypertension; to master the 4 Hypertension 4 classification, risk stratification, hypertensive crisis, diagnosis and treatment of hypertensive encephalopathy Coronary To master the characteristic symptoms of typical angina atherosclerotic heart and treatment principles; to master the clinical 5 disease Angina manifestations, diagnosis, differential diagnosis, and 2 Myocardial prevention and management strategies for myocardial infarction infarction To master the cause of heart failure, the characteristics of the pathophysiology, clinical manifestations, diagnosis, Heartfailure（cardiac differential diagnosis and treatment principles; to 6 2 dysfunction） understand the reasonable prescription of digitalis, diuretics, vasodilators, angiotensin-converting enzyme inhibitors, β-receptor blocking agents To master the classification, clinical manifestations, and characteristics of blood and bone marrow test; to master 7 Leukemia 4 the diagnosis and treatment principles; to understand the pathogenesis and prognosis. To master the clinical manifestations, diagnosis and 8 Peptic ulcer differential diagnosis, complications, and management 4 principles; to understand the pathogenesis and etiology To master the clinical manifestations, diagnosis, Cirrhosis Hepatic 9 complications, and management principles of 4 encephalopathy posthepatitic cirrhosis; to understand the pathogenesis

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and differential diagnosis; to master the symptoms, diagnosis and differential diagnosis, complications, and management principles of hepatic encephalopathy; to understand the cause and pathogenesis. To master the four most common cause; to master the Upper identification, the determination of the bleeding amount 10 gastrointestinal 2 and the possibility forof continued bleeding; to master bleeding the therapeutic principles. To understand the developmental process of the disease; to master the key points forof clinical manifestation and 11 Acute pancreatitis 2 diagnosis; to mater the methods for prevention and treatment. To master definition and characteristics of glomerular disease, and classification of primary glomerular disease; 12 Glomerular disease to master the clinical manifestations, diagnosis, 4 differential diagnosis, and management principles; to understand the etiology and pathogenesis. Chronic renal failure To understand the etiology and pathogenesis; to master 13 4 (uremia) the diagnosis and management principles To understand the concepts and classifications of the disease; to master the symptoms and complication based 14 Diabetes on the pathophysiological change; to master the 4 diagnosis criteria, the management principles(the diagnosis and management of ketoacidosis) To understand the etiology and pathogenesis; to master 15 Rheumatoid arthritis the symptoms, diagnosis, differential diagnosis and 2 management principles Systemic lupus To master the symptoms, lab examination, diagnosis and 16 2 erythematosus management principles.

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Teaching Management and Precautions 1. Students are required to carefully review the related contents of the course before the clerkship. 2. Tutors will remind students the requirements and precautions during the clerkship. 3. Clerkship will be organized asin small groups. Students will be able to sit down and take an extended history and physical examination fromof a patient. 4. Students are required to fully understand the contents of clerkship with guidance of tutors and to do after-school review. Assessment and Grading Percentage 1. The grade is based on the attending and tutors’ evaluations in terms of history taking, answers to questions and quizzes in class. 2. The grade is worth 20% of the final score.

Ⅳ. Practice Requirements The clinical practice of internal medicine is a process for students to learn how to apply theory knowledge and skills to solve clinical problems. 1. Students should be able to elicit the patient’s chief complaint, history of present illness, past medical history, social, family, occupational histories and complete a review of systems. 2. Perform a physical examination in a logical, organized and thorough manner. 3. Demonstrate the ability to record the history and physical exam in a legible and logical manner 4. Demonstrate the ability to write daily progress notes on the ward. 5. Demonstrate the ability to discuss the likely diagnosis and plan of treatment of common disease, the treatment of medical emergency 6. be able to do first aid and basic care work in clinic 7. master routine laboratory tests of blood, urine, feces, sputum, puncture fluid

Ⅴ. Ability Training Requirements Upon completion of this subject, students will be able to: 1. Apply theoretical knowledge to analyze the patient history obtained through interview and physical examination and to discuss the likely diagnosis and plan of treatment for common disease 339

2. Develop the skills of common clinic operations, first aid and basic care techniques 3. Demonstrate self-learning ability to summarize and internalize knowledge, to expanding knowledge by reading reference books and papers

Ⅵ.Hours Distribution Clinical Clinical Content Lecture clerkships practice Respiratory system 21 2×4 Introduction 1 Chronic obstructive pulmonary disease 2 Pulmonary hypertension and pulmonary heart 2 disease Bronchial asthma 2 Respiratory failure 2 Pneumonia 3 Tuberculosis 4 Primary bronchogenic carcinoma 3 Pleural disease 2 Cardiovascular system 21 3×4 Introduction 1 Heart failure 3 Arrhythmia 3 Hypertension 2 Artery atherosclerosis and coronary atherosclerotic 4 heart disease Valvular disease of the heart(VDH) 2 Myocardial diseases 2 Pericardial disease 2 Interventional therapy of cardiovascular disease 2 Digestive diseases 24 3×4 Introduction 2 340

Gastritis 2 Peptic ulcer 3 Gastric cancer 2 Intestinal tuberculosis and tuberculous peritonitis 2 Inflammatory bowel disease 2 Cirrhosis 3 Primary liver cancer 2 Hepatic encephalopathy 2 Acute pancreatitis 2 Upper gastrointestinal bleeding 2 Urinary system disease 9 1×4 Introduction 1 Primary glomerular disease 2 Nephrotic syndrome 1 Urinary tract infection 1 Acute kidney injury 1 Chronic renal failure 2 Blood purification therapy 1 Hematopoietic system diseases 14 4 Introduction and anemia overview 1 Iron deficiency anemia 1 Aplastic anemia 2 Warm antibody autoimmune hemolytic anemia 1 Myelodysplastic syndrome 1 Leukemia: 5 Lymphoma 1 Plasma cell disease 1 Thrombocytopenia purpura 1 Endocrine and metabolic diseases 10 4 Introduction 1

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Pituitary hypothyroidism 1 Hyperthyroidism 2 Thyroid hypofunction 1 Cushing's syndrome 1 Diabetes 4 Connective tissue disease and rheumatic diseases 6 4 Introduction 1 Rheumatoid arthritis 2 Systemic lupus erythematosus 3

Ⅶ. Assessment

Attendance and Performance 15% Clinical Clerkship 20% Midterm exam 25% Final Test 40% Total 100%

Ⅷ.Textbook and references Text Book Joseph, JY Sung, Ji-yao WANG, Ti Shen Essential Internal Medicine. People’s Medical Publishing House, 2009 Reference Books Cecil‘s Essentials of Medicine Useful web sites Harrison’s Internal Medicine online http://www.ncbi.nlm.nih.gov/pubmed/

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Medical Obstetrics and Gynecology

Credits: 5 Total hours: 96 Lectures hours: 64 Experiment hours 32 Grade: 4th Semester: 2 Hong Yu Yun-Lang Cai Yang Shen Hai-Ling Li Compilers: Hai-Jung Zhao Yan Hu Wang Yan Jing-Ying Zhang Email: [email protected]

Preface Obstetrics and Gynecology is the mainone of the most important curriculum in the field of clinical medicine. It is the subject towhich investigates health care of women, and prevention and care of ailment on the basis of the change of reproductive system in the lifetime of a woman and trait ofthe physiological and pathological traits related to pregnancy and fetus. It includes obstetrics, gynecology, female healthcare, birth control and eugenism. The student will mastery of the basic theory, basic information and basic skills after learning this course andthat will be beneficial to the foundation of theory and practice for the future work as a clinician. According to the pedagogic plan, the course time is: academic time 58 hours, clinically-based learning 30 hours. Totally is 88 hours.

Ⅰ. Preamble and Objectives： Obstetrics and gynecology is a subject of the studying of female physiology, and pathology and birth control, including obstetrics, gynecology and family planning. Obstetrics is the study of physiology and pathology subject of pregnancy and delivery process of both maternalmother and fetus. It includes: Pregnancy, Delivery, Puerperium , Pregnancy at Risk, abnormal labor, Complications of Labor and Puerperium, Fetus and Perinatology, etc. Gynecology is a subjectthe of studying of the physiology and pathology of the female

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reproductive physiology and pathologysystem. It includes: female anatomy, female physiology, female endocrinology, female genital tumors, female genital system infection, abnormal menstruation, endometriosis, Female genital organ damage and deformity and infertility, etc. Family planning study the timing of fertility, eugenics, contraception and treatment of unwanted pregnancy treatment, etc. The student will mastery of the basic theory, basic information and basic skills after learning this course andwhich will be beneficial to the foundation of theory and practice for the future work as a clinician.

Ⅱ. Contents of the Course and Requirements： Chapter 1. Anatomy of The Female Reproductive System To master 1. Types of pelvis. 2. The anatomy of uterus. To be familiar with 1. Anatomy of female pudendum and inner genitalia and the relationship with organs of vicinity. 2. The shape and configuration of female pelvicpelvis and the anatomic characteristics related with delivery. To understand The distribution of primary blood vessel, lymphatics and nerves and the anatomyic character of female pelvic floor.

Chapter 2. Physiology of Reproduction in Women To master 1. Ovarian function and periodical change. 2. The physiological action of sex hormone. 3. The clinical symptom of regular menstrual cycle and periodical change of endometrium. To be familiar with 1. Be familiar with the change of reproductive endocrinology and clinical symptoms at the respective stage in the female lifetime. 2. The periodical change of reproductive organs 3. The adjustment of menstrual cycle. 344

To understand Synthesis and secretion of sex hormone

Chapter 3. Normal Pregnancy To master 1. Diagnostic methods and principles of each stage (the first, second, third trimester) onof normal pregnancy. 2. The prenatal care methods 3. The development and function of the placenta. 4. Calculate expected date of confinement To be familiar with 1. The process of maternal physiology of pregnancy(emphases on reproductive system, hematologic system, cardiovascular system and urinary system).. 2. The growth, development and physiologic traits of fetus. 3. The method of pelvic examination. To understand 1. Fertilization and the development, transport and imbed of conceptus. 2. Assessment of prenatal diagnosis and fetal well-being.

Chapter 4. Pregnancy at Risk To master 1. The management principle of high-risk pregnancy. 2. The definition and clinical findings and diagnosis of abortion and ectopic pregnancy. 3. The definition, clinical findings and treatment of preterm labor and premature rupture of membranes. 4. The pathologic and physiologic change, classification, standard of diagnosis and treatment of hypertension states of pregnancy. 5. The definition, classification, diagnosis and management principle of placenta previa. 6. The definition, diagnosis and treatment of premature separation of the placental. To be familiar with 1. The methods offor assessment forof pregnancy at risk. 2. The etiology, classification and management principle of abortion 345

3. The etiology, special examinations of ectopic pregnancy. 4. The definition and management of prolonged pregnancy. 5. The pathogenesis, treatment and complications of multiple ??? 6. The complications of premature separation of the placental. To understand 1. The effect of environmental factors and inheritgenetic factors on fetalfetus and the significance in the prenatal diagnosis. 2. The differentiatedifferential diagnosis of ectopic pregnancy. 3. The relevant factors of hypertension states of pregnancy. 4. Rh isoimmunization and ABO hemolytic disease.

Chapter 5. Fetal Dysplasia and Fetal Death To master The definition of macrosomia and intrauterine growth restriction (IUGR). To be familiar with 1. The complications of macrosomia. 2. The classification, clinical findings and treatment of IUGR. To understand The cause of IUGR.

Chapter 6. Pregnancy with Internal Medical Diseases To master 1. Cardiovascular changes in normal pregnancy. 2. The definition and diagnostic criteria for gestational diabetes mellitus. To bebfamiliar with 1. The main diagnostic point and the principle of prevention and treatment for heart disease. 2. The clinical findings, complications and treatment of viral hepatitis. 3. The diagnosis and the management principle of renal disease complicating pregnancy as well as the mutual influence on pregnancy. 4. The complications, treatment, antepartum care of gestational diabetes mellitus. To understand 1. Heart disease complicating pregnancy: mutual influence between heart disease and pregnancy 346

and labor. 2. Acute viral hepatitis complicating pregnancy: liver physiologic change with pregnancy and the way of prevention and treatment. 3. The clinical presentation, diagnosis and management principle of acute pyelonephritis complicating pregnancy.

Chapter 7. Pregnancy with Surgical Diseases To master The treatment of acute appendicitis. To be familiar with The clinical and signs of acute appendicitis. To understand The clinical findings and treatment of cholecystitis and cholelithiasis.

Chapter 8. Normal Labor To master 1. Four determinate factors of labor. 2. The definition and section of labor stages 3. Signs of placental separation.. To be familiar with 1. The mechanism of occipital presentation 2. Characteristics of normal labor. 3. The clinical process of labor and management. 4. The maternal change at puerperium and physiologic trait of neonatalneonate

Chapter 9. Abnormal Labor and Dystocia To master 1. The definition of dystocia, generally contracted pelvic, persistent occiput transverse. 2. Clinical presentation manifestation effect on mother and fetalfetus and of abnormalities of the powers. 3. The classification and diagnosis of hypotonic uterine dysfunction. 4. The definition and diagnosis of abnormal patterns of labor. 347

5. The classification of contracted pelvic. To be familiar with 1. The diagnosis and treatment of hypertonic and uncoordinated uterine dysfunction. 2. The diagnosis of contractions of the pelvic. 3. The diagnosis and treatment of soft-tissue dystocia. 4. The effect and the treatment of abnormalities of the passage and passenger. 5. The classification and mechanism of labor of breech presentation To understand 1. The cause of abnormal labor --- abnormalities of the powers, the passage and passenger. 2. Clinical finding, complications and treatment of shoulder dystocia.

Chapter 10. Complications of Labor and Puerperium To master 1. The clinical findings, diagnosis, prevention and treatment of uterus rupture. 2. The definition, cause, clinical presentation and diagnosis of postpartum hemorrhage. 3. The definition of puerperal infection and puerperal morbidity. To be familiar with 1. The cause, classification of rupture of the uterus. 2. The clinical findings, diagnosis of amniotic fluid embolism. 3. The prevention and treatment on postpartum hemorrhage. 4. The common pathogens in puerperal infection, change of pathology and clinical presentation. To understand 1. The pathophysiology and clinical findings of amniotic fluid embolism. 2. The clinical findings and prevention of puerperium depression.

Chapter 11. Obstetric Analgesia and Anesthesia To be familiar with The indications of obstetric analgesia and anesthesia. To understand The undesirable side effects of anesthesia.

Chapter 12. Drugs in Pregnancy 348

To master The FDA classification of teratogenicity. To be familiar with Drugs of choice in pregnancy.

Chapter 13. Gynecological History and Examination To master 1. The characteristic to write history taking of gynecological diseases. 2. The methods of recording gynecological examination. To be familiar with The methods of bimanual examination ,trimanual examination To understand The diagnosisdiagnostic laboratory test of gynecological examination.

Chapter 14. Identification of Common Symptoms and Signs To be familiar with The common causes of abnormal vaginal bleeding, abnormal leucorrhea, pelvic mass, pelvic pain.

Chapter 15. Female Genital System Infection To master 1. The clinical presentations , diagnosis standard and treatment principle of vulvovaginal candidiasis, bacterial vaginosis. 2. The clinical findings of cervicitis. 3. The clinical findings and diagnosis of acute salpingitis-peritonitis. 4. The clinical findings and diagnosis of chronic pelvic infection. To be familiar with 1. Natural defence ability of the female reproductive system. 2. The clinical findings and treatment of Bartholin’s duct cyst and abscess. To understand 1. The clinical findings and treatment of pelvic abscess. 2. The transmitted paths , clinical presentations , diagnosis and the principle of 3. treatment in pelvic tuberculosis. 349

Chapter 16. Sexually Transmitted Diseases To master The modes of transmission and prevention of human immunodeficiency virus (HIV). To be familiar with 1. The clinical findings of clinical findings of gonorrhea, syphilis, chlamydial infections, herpes simplex, human papillomavirus. 2. The treatment of syphilis in pregnancy. To understand The management of HIV infection during pregnancy.

Chapter 17. Female Genital Tumors To master 1. The definition and pathological staging of cervical intraepithelial neoplasia. 2. The early diagnostic methods and clinical staging, metastasis of cervical cancer. 3. The classifications, secondary changes, clinical findings and therapy of myoma. 4. The complications, route of spread and categories of ovarian cancer. To be familiar with 1. The specific characteristic of cervical tissue. 2. The differential diagnosis and treatment of leiomyoma 3. The clinical characteristic, metastasis of endometrium carcinoma. 4. The clinical findings, diagnosis and principle of management ofon ovarian cancer. 5. The differential diagnosis between the malignant and benign ovarian cancer. To understand 1. The etiology, pathology, clinical findings, principles of treatment, prevention and prognosis onof cervical cancer. 2. The etiology, pathology, clinical staging, diagnostic method and principle of management and prevention onof endometrium carcinoma. 3. The high-risk factors, pathology, clinical staging, prevention and prognosis of ovarian cancer.

Chapter 18. Gestational Trophoblastic Diseases To master 350

1. The definition of hydatidiform mole, invasivemole and choriocarcinoma. 2. The clinical findings of complete hydatidiform mole. To be familiar with 1. The pathology, clinical findings, diagnosis, treatment and follow-up visit of hydatidiform mole, invasivemole and choriocarcinoma. 2. The clinical classification of malignant gestational trophoblastic disease. To understand The differential diagnosis of hydatidiform mole, and choriocarcinoma.

Chapter 19. Normal and Abnormal Menstruation To master 1. The pattern and diagnosis of abnormal uterine bleeding. 2. The definition of amenorrhea. 3. The definition and clinical findings of perimenopause syndrome. To be familiar with 1. The endocrine characteristic of puberty. 2. The major etiology, mechanism and treatment of dysfunctional uterine bleeding 3. The causes of postmenopause bleeding. 4. The diagnostic methods of amenorrhea. 5. The methods of estrogen replacement. To understand 1. The principle of management of abnormal uterine bleeding. 2. The clinical features of dysfunctional uterine bleeding. 3. The causes, clinical findings and treatment of amenorrhea.

Chapter 20. Endometriosis Disease To master The definition of endometriosis disease and adenomyosis. To befamiliar with 1. The pathogenesis, clinical findings, diagnosis and treatment of endometriosis disease. 2. The clinical findings of adenomyosis. To understand 351

1. The etiology and classification of endometriosis disease. 2. The diagnosis and treatment of adenomyosis.

Chapter 21. Infertility And Assisted Reproductive Techniques To master The definition of infertility. Tobefamiliar with The female factor and diagnosis of infertility. To understand 1. The examination method and therapy of infertility. 2. In vitro fertilization and related techniques.

Chapter 22. Relaxation of Pelvic Supports (Genital Traumatic Diseases) To master Description and staging of pelvic organ prolapse. To be familiar with The etiology, clinical findings, diagnosis ,differential diagnosis and prevention of uterine prolapse. To understand 1. The clinical findings, treatment and prevention of cystocele, trethrocele, rectocele. 2. The treatment of uterine prolapse.

Chapter 23. Urogynecology To master The definition of urinary incontinence. To be familiar with The etiology ,diagnosis and treatment of urinary incontinence To understand The anatomy of urinary tract.

Chapter 24. Family Planning To master 1. The mechanism of hormonal contraception, intrauterine contraceptive devices (IUD). 352

2. The complications of artificial abortion. To be familiar with 1. Insertion method, complications and side effects of IUD. 2. The definition of emergency contraception. 3. The methods of induced abortion. To understand 1. The indication, contraindication of hormonal contraceptives, induced abortion and emergency contraceptive.. 2. The types of oral hormonal contraceptives and IUD. 3. The methods and complication of female sterilization. 4. Choices of family planning.

Ⅲ. Practice Requirements 1. Master the basic knowledge and principles of the Obstetrics and Gynecology and to learn the commonly used diagnosing and treating operations. 2. Learn to write of medical records of hospitalized patients and the course of the disease punctually and accurately. Improve abilities of analyzing and solving problems that occur in the medical practice. 3. The clerkshipintern should be sympathetic to the patients, have a high sense of duty to the patients, observe the course of the disease closely, report to the senior doctor, and undertake the diagnosis and treatment work under the guidance of the senior doctors. 4. When undertaking the gynecologic examinations there must be a third female person present. Report the course of the disease when the senior doctors check the patient, put forward the opinions about the treatment and take part in the lectures. The total times of the lectures should not be less than 3 .

Ⅳ. Ability Training Requirements Upon completion of this subject, students will be able to: Obstetrics 1. Master the characteristics of the case history of Obstetrics and be able to write the medical records of outpatient and inpatient, the antenatal visit, intrapartum record, postpartum record and neonatal record completely and timely. 353

2. Master the methods of Leopold maneuvers, external measurement of pelvic, anal digital examination. 3. Master the methods of fetal heart monitoring, non –stress test(NST), oxytocin challenge test(OCT) and intravenous oxytocin induction. 4. Master the method and procedure of a normal delivery, the management of normal neonates and Apgar score. 5. Master the clinical course and management of childbed, the treatment principles of the symptoms of normal puerperium, like uterine contraction pain, urinary retention, milk bulging, chapped nipple, hemorrhoids and genital swelling. Perform suture removal independently. 6. Master the management of the common symptoms of pregnancy such as anemia, orthostatic hypotension, lower extremity muscle crap, varicose veins and lower extremity edema, etc. 7. Master the diagnosis and management of the special complications such as hypertension and diabetes mellitus in pregnancy. 8. Master the indications of cesarean section. Acting as second assistant of cesarean section. Gynecology 1. Master the writing of the medical records of outpatient, inpatient and emergency patient. 2. Master the bimanual examination method and the vagino-recto-abdominal examination and can judge the status of external genitalia, vagina, cervix, uterus and the annex, etc. 3. Master the indications, procedure and significance of the special examinations such as cervical smear, posterior fornix smear, trichomonas and mold inspection and basic temperature measurement. 4. Master the indication, contradiction and the complication of early pregnancy abortion, drug abortion, implantation and removal of intrauterine contraceptive devices, induction of medium-term pregnancy, oviduct ligation and other contraceptive methods. 5. Master the diagnosis and treatment of the common diseases of the outpatient department such as vulvitis, vaginitis, chronic cervicitis, female genital infection, pregnancy miscarriage and menstrual disorders. 6. Master the dosage and usage of common gynecologic medicines, common chemotherapy method of female genital malignant tumor. 7. Master the preoperative examinations, preparations, the postoperative management and the prevention of complications of the gynecological surgeries. 8. Master the methods of implantation and removal of intrauterine devices and artificial 354

abortion. 9. Acting as second assistant of annex resection and hysterectomy.

Ⅴ.Hours Distribution Content Lecture Discuss Lab Clinical Clerkship 58 30 Anatomy and Physiology of Reproduction 2 3 in Women Pregnancy physiology 2 Diagnosis of pregnancy 2 3 Spontaneous Abortion 2 Ectopic Pregnancy 2 Preterm Labor 2 3 Premature Rupture of Memberanes Hypertensive state of Pregnancy 2 Premature Separation of the Placenta 2 3 Placenta Previa Fetal Dysplasia and Fetal Death 2 Pregnancy with Angiocardial system 2 3 Diseases Gestational Diabetes Mellitus 2 Normal Labor 2 3 Abnormal Labor and Dystocia 2 Rupture of the Uterus 2 Amniotic Fluid Embolism Postpartum Hemorrhage 2 Puerperal infection 2 3 Puerperium Depression 2 Vulvovaginal Infection 2 Cervicitis 2 Pelvic Inflammatory Disease

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Sexually transmitted disease 2 Premalignant and Malignant Disorder of 2 3 uterine Cervix Leiomyoma of Uterus 2 Endometrial Carcinoma Malignant Disorder of the Ovary and 2 Oviducts Gestational Trophoblastic disease 2 Abnormal Uterine Bleeding 2 3 Amenorrhea 2 Perimenopause Syndrome Endometriosis disease 2 Infertility and Assisted Reproductive 2 Techniques Family Planning 2 3

Ⅵ. Assessment

Coursework 10% Attendance and Performance 10% Quizzes 10% Clinical Clerkship 10% Final Test 60% Total 100%

Ⅶ.Textbook and references Text Book TESTBOOK OF OBSTETRICS &GYNECOLOGY Reference Books 1. << Precis: Gynecology, 4th Edition >> 2. <>

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3. <> 4. << ICD-9-CM Abridged: Diagnostic Coding in Ob-Gyn 2012 >> Journals 1. <> 2. << American Journal of Obstetrics and Gynecology>> 3. <> Useful web sites 1. http://www.acog.org/ 2. http://www.ispog.org/

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Medical Stomatology

Credits: 1.5 Total hours: 24 Lectures hours: 24 Grade: 4th Semester: 2 Yao-Zhong Chen Yong Yu Bin Li Compilers: Zong-Yun Fu Hong-Li Song Email: [email protected]

Ⅰ. Preamble and Objectives Oral medicine is a part of clinical medicine. The Task of course is to investigate the diseases of teeth , cement and soft and sclerous tissues around maxillofacial region, the relationship between these and systemic disease and prevention and cure of these disease. It includes Cariology, endodontology, periodontology and oral medicine. The student will master the basic theory, basic information and basic skills after learning this course and this will be beneficial for the future work as a clinician.

Ⅱ. Contents and Requirements Part 1. Oral-Maxillofacial Clinical Examination Chapter 1. Steps for Thorough Maxillofacial Examination To be familiar with 1. Extraoral examination 2. Intraoral examination

Chapter 2. The General Description of Teeth To master 1. The primary dentition 2. The mixed dentition 3. The permanent dentition 4. Tooth anatomy

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To be familiar with Dental notation

Chapter 3. Clinical Examination of Teeth To master 1. Calculus 2. Materia alba 3. Dental plaque 4. Tooth mobility To be familiar with 1. General characteristics 2. Development defects

Chapter 4. The Gingival Examination To master 1. Gingival colour 2. Gingival bleeding 3. Gingival shape 4. Gingival position 5. The normal occlusion 6. Malocclusion 7. Types of facial profile To be familiar with 1. Gingival size 2. Gingival consistency 3. Gingival surface texture 4. Gingival exudate To understand Malrelation of groups of teeth

Part 2. Dental Care and Prevention Chapter 1. Dental Care 359

To master 1. The primary dentition 2. The mixed dentition 3. Tooth-brushing methods 4. Frequency of brushing 5. Scaling To be familiar with 1. Toothbrush 2. Mouth rinses 3. Inter teeth Cleaning

Chapter 2. Prevention To master Types of disease prevention

Part 3. Dental caries and Disease of Dental Hard Issues Chapter 1. Dental Caries To master 1. The definition of dental caries 2. Caries etiology To be familiar with 1. the principle of prevention 2. The clinical findings. 3. Anatomy of tooth Structures To understand 1. The use of fluorides 2. A pit and fissure sealant

Chapter 2. Disease of Dental hard Tissues To master 1. The definition of Tetracycline Pigmentation and Hypersensitive Dentine 2. Prevention 0f Wedge-Shaped Defect 360

To be familiar with 1. The clinical findings of Dental Fluorosis 2. Etiology of Hypersensitive Dentine To understand 1. The clinical findings of Hypersensitive Dentine 2. Prevention of Tetracycline Pigmentation

Part 4. Diseases of the Dental Pulp and the Periapical Tissues To master 1. Etiology of Pulpitis and Periapical Periodontitis 2. Characteristics associated with pulpal pain and Periradicular Pain To be familiar with 1. The classification, clinical findings of pulpal pain and Periradicular Pain 2. Diagnosis methods and principle of Pulpitis and Periapical Periodontitis To understand 1. Examination and Treatment Principle 2. Emergency treatment

Part 5. Gingival and Periodontal Disease To master 1. The definition of Periodontal tissue, Gingivitis, Periodontitis and Periodontal Abscess. 2. The clinical manifestations of Simple Gingivitis, Necrotizing Ulcerative Gingivitis, Simple Periodontitis and Periodontal Abscess. 3. Differential diagnosis between Periodontal and Periapical abscess. To be familiar with 1. The Cause and Mechanism of Simple Gingivitis, Necrotizing Ulcerative Gingivitis, Simple Periodontitis and Periodontal Abscess. 2. The treatment of Simple Gingivitis, Necrotizing Ulcerative Gingivitis, Simple Periodontitis and Periodontal Abscess. To understand 1. Drug-Induced Gingival Hyperplasia. 2. Gingivitis in Pregnancy. 361

3. The pathology of Simple Gingivitis, Necrotizing Ulcerative Gingivitis, Simple Periodontitis and Periodontal Abscess.

Part 6. Oral Mucosa Disease To master 1. The definition of Lichen planus, Acute Moniliasis (Thrush), Pemphigus Vulgaris, Minor Aphthous Ulcer, Leukoplakia and Herpetic Stomatitis. 2. The clinical manifestations of Lichen planus, Acute Moniliasis (Thrush), Pemphigus Vulgaris, Minor Aphthous Ulcer, Leukoplakia and Herpetic Stomatitis. 3. The treatment of Minor Aphthous Ulcer. To be familiar with 1. The Cause and Mechanism of Lichen planus, Acute Moniliasis (Thrush), Pemphigus Vulgaris, Minor Aphthous Ulcer, Leukoplakia and Herpetic Stomatitis. 2. The treatment of Lichen planus, Acute Moniliasis (Thrush), Pemphigus Vulgaris, Leukoplakia and Herpetic Stomatitis. To understand 1. The Pathology of Lichen planus, Acute Moniliasis (Thrush), Pemphigus Vulgaris, Minor Aphthous Ulcer, Leukoplakia and Herpetic Stomatitis. 2. The differential diagnosis of Lichen planus and Pemphigus Vulgaris.

Part 7. Oral Maxillofacial Infection Chapter 1. Characteristic of Maxillofacial Infection To master 1. Characteristic of local anatomy and physiology and inflammation. 2. Etiology of oral and maxillofacial infections. To be familiar with 1. Pathogens and infection types. 2. Clinical symptoms of Infections. To understand 1. Definition of Infection and Inflammation. 2. Treatment: Local treatment/Systemic treatment.

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Chapter 2. Pericoronitis in the Mandibular Third Molar To master 1. Definition of Pericoronitis in the third molar. 2. Clinical manifestations: Local manifestations/Systemic symptoms. To be familiar with 1. Etiology: Anatomical factors/Environmental factors. 2. Treatment principles. To understand Infection spread to the gap.

Chapter 3. Oral and Maxillofacial Space Infection To master 1. Infraorbital space infection: Clinical manifestations and Treatment. 2. Masseteric space infection: Clinical manifestations and Treatment. To be familiar with Anatomy of Infraorbital space and Masseteric space To understand Definition, Etiology, Pathogens and Range.

Chapter 4. Osteomyelitis of the Jaws To be familiar with Clinical manifestations: acute phase/chronic phase. To understand Definition, Common types, Anatomical characteristics and Treatment.

Chapter 5. Salivary and Submandibular Gland Inflammation To be familiar with Clinical manifestations: Acute suppurative parotitis/Chronic suppurative parotitis. To understand Anatomy of the parotid gland/Submandibular gland, characteristics and Treatment.

Part 8. Wounds and Injuries of The Soft Tissues and Hard Tissues of The Facial 363

Area Chapter 1. Emergency Care To master Emergency Treatment: Principles. To be familiar with 1. Asphyxia: Cause/Prevention and Cure. 2. Control Hemorrhage. 3. Treat shock: cause/treatment To understand 1. Check for Associated Injuries. 2. Prevention of Infection 3. Binding up

Chapter 2. Wounds of the Soft Tissues To master 1. Principles of treatment of the soft tissues in facial area. 2. Cleansing/Debridement/Hemostasis/Closure of wound. To be familiar with 1. Definition and Characteristics of Abrasion/Contusion/Penetrating wound/Laceration. 2. Principles of treatment of Lingual injury. 3. Treatment of Penetrating wound of cheek. 4. Closure of Lip injury. To understand Principles of treatment of palatal injury/nose/Eyelid

Chapter 3. Injury of the Hard Tissues To master 1. Definition and Character of LeFort I, II, or III in Midface Fractures. 2. Signs and symptoms of Facial fractures. 3. Basic surgical principles/ treatment of Facial fractures. 4. Approaches for Internal rigid fixation in the facial fractures. To be familiar with 364

1. Classification and Incidence of Mandibula Fractures. 2. Displacement and Malocclusion in the injury of the hard tissues. To understand 1. Etiology of injury in the hard tissues. 2. Reduction and Fixation of Facial fractures

Chapter 4. Zygoma Fractures To master Symptoms of Zygoma Fractures. To be familiar with Principles of Treatment. To understand 1. Treatment of Blowout Fracture. 2. Treatment of NOE Fracture. 3. Treatment of Panfacial Fracture.

Chapter 5. Injuries of Teeth To master 1. Symptoms and Classification of injures in teeth. 2. Principle of treatment in Crown Facture. 3. Clinical manifestations and Treatment of luxated teeth or avulsion of tooth. To be familiar with 1. Horizontal or Vertical classification of Crown Fracture. 2. Clinical manifestations: Displacement of tooth. 3. Definition and Treatment of Alveolar fractures. 4. Principles of treatment of Intrusion in Tooth injury. To understand 1. Cause of Dentoalveolar Injuries. 2. Stabilization Periods for Dentoalveolar Injuries. 3. Storage medium of the luxated teeth. Part 9. Oral-Maxillofacial Tumor Chapter1. Oral Cysts 365

To master Definition and distinguish soft tissues Cysts and jaws cysts To be familiar with 1. Types of the soft tissues cysts 2. Types of the jaws cysts To understand Treatment of the cysts. Chapter2. benign To master Classification of Benign tumors To be familiar with Symptoms and diagnosis of the benign tumors To understand Treatment of the benign tumors Chapter 3. Carcinoma of the Oral Cavity To master 1. Symptoms of the carcinoma of the oral cavity 2. Diagnosis of the carcinoma of the oral cavity To be familiar with Treatment of the carcinoma of the oral cavity. To understand Cause of the carcinoma of the cavity. Chapter 4. Salivary Glands Malignant Tumors To master Symptoms and clinical signs of Mucoepidermoid Carcinoma To be familiar with Treatment of the Mucoepidermoid Carcinoma

Ⅲ.Hours Distribution Content Lecture Oral-Maxillofacial Clinical Examination 2

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Dental Care and Prevention 2 Dental Caries and Diseases of Dental Hard Tissues 2 Diseases of Dental pulp and periapical Tissues 4 Gingival and Periodontal Disease 4 Oral Mucosa Disease 2 Oral Maxillofacial Infection 2 Wounds and Injuries of The Soft Tissues and Hard Tissues of The Facial Area 4 Oral-Maxillofacial Tumor 2

Ⅳ.Assessment Coursework 20% Attendance and Performance 20% Quizzes 20% Clinical Clerkship 20% Final Test 20% Total 100%

Ⅴ.Textbook and references Tao Hong, Huang Yali. Stomatology Deans Office of Xi’an Jiaotong University, November 2004

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Neurology and Psychiatry

Credits: 2.5 Total hours: 52 Lectures hours: 40 Experiment Hours 12 Grade: 5th Semester: 1 Zhi-Jun Zhang Fu-Lin Yan Zhou Hong Ren Qin-Guo Compilers: Guo Yi-Jing Yuan Yong-Gui Rong Xiang Email:[email protected]

Preface Neurology is a discipline that deals with the study of the disorders of the central nervous system, peripheral nervous system and muscular system. Due to the complexity of neurologic structures and diseases, Neurology is always regarded as one of the most difficult medical specialties by many students. So, before you start the study, here is a suggestion for you. Make a brief review of neuroanatomy, which will help you to understand better, the neurological signs and symptoms, then the diseases. All medical students should acquire and maintain some basic knowledge, theories and skills in neurology, and master the diagnosis and management of common neurological disorders. Psychiatry is the medical specialty devoted to the study of diagnosis, treatment, and prevention of mental disorders. The major psychiatric diagnostic categories will be addressed. including: affective disorders, schizophrenia, anxiety disorders, geriatrics disorders and somatization disorders. When appropriate, basic science correlations are also addressed. The Psychiatry course provides fourth year students with a solid foundation in the fundamentals of the evaluation, diagnosis and treatment of patients with mental health disorders. This syllabus is based on the textbook of neurology. It uses ‘master, be familiar with and understand’ to show the different demands.

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Ⅰ. Preamble and Objectives Neurology and Psychiatry are two different courses that together both comprehensively study the parenchymal and functional diseases of central and peripheral nervous system. General objective of this course is to enable international students to acquire some certain principles of common diseases, such as acute cerebrovascular disease, epilepsy, Parkinson disease, schizophrenia, depressive and anxiety disorders, as well as skills for clinic practice, e.g. neurological examination, lumbar puncture.

Ⅱ. Contents and Requirements Chapter 1. General Introduction Part 1. Motor system To master: 1. The differentiation of upper and lower motor neuron lesion. 2. Localization of paralysis. To be familiar with: 1. Types of motor neurons. 2. Four parts of Extrapyramidal system. To understand: 1. Common tendon reflexes and their central location. 2. Common clinical manifestation of involuntary movements. Part 2. Sensory system To master: The two types of sensory disorder, the several manifestation of stimulating symptom. To be familiar with: Localization of sensory disturbance. To understand: Sensory pathway and their function. Part 3. Cranial nerves To master: The name of cranial nerves and their nuclei. To be familiar with Visual field defects of impaired vision in various locations. 369

To understand Main clinical manifestation of oculomotor nerve paralysis. Part 4. Lesion of the lobes of the brain To master: 1. Clinical manifestation of the lesion in frontal lobe. 2. Clinical manifestation of the lesion in parietal lobe. 3. The cardinal feature of the brain stem lesion. 4. The cardinal feature of the internal capsule. To be familiar with: 1. The characteristics and lesion site of motor dysphasia. 2. The characteristics and lesion site of sensory dysphasia. To understand: 1. Main manifestation of the lesion in temporal lobe. 2. Main manifestation of the lesion in occipital lobe.

Chapter 2. Peripheral Nerve disease Part 1. Trigeminal neuralgia To master: The clinical manifestation and diagnosis of trigeminal neuralgia. To be familiar with: The therapy of trigeminal neuralgia. To understand: The etiology of trigeminal neuralgia. Part 2. Bell's palsy (Idiopathic facial palsy) To master: The clinical manifestation and diagnosis of bell's palsy. To be familiar with: The therapy of bell's palsy. To understand: The etiology of bell's palsy. Part 3. Acute inflammatory demyelinating polyradiculoneuropathy ( Gullain-Barre’ syndrome GBS) 370

To master: The clinical manifestation and diagnosis of Gullain-Barre’ syndrome. To be familiar with: The differential diagnosis and treatment principles of Gullain-Barre’ syndrome. To understand: The etiology of Gullain-Barre’ syndrome.

Chapter 3. Spinal Cord Disease Part 1. Anatomy of the spinal cord To master: The skin sectional innervation of spinal cord. To be familiar with: The clinical effects of spinal cord injury. Part 2. Transverse myelitis To master: The clinical manifestation of transverse myelitis. To be familiar with: The treatment and nursing of transverse myelitis. To understand: The etiology of transverse myelitis. Part 3. Spinal cord compression To master: The clinical manifestation of Spinal cord compression. To be familiar with: The diagnosis, differential diagnosis and treatment principle of Spinal cord compression. To understand: The etiology of Spinal cord compression.

Chapter 4. Cerebrovascular Disease To master : The clinical manifestation, diagnosis, differential diagnosis and treatment principle of cerebral infarction, cerebral hemorrhage and subarachnoid hemorrhage. 371

To be familiar with: The conception, manifestation and treatment of transient ischemic attack. To understand: The classification, risk factor and prevention of cerebrovascular disease.

Chapter 5. Epilepsy To master The clinical manifestation and diagnosis of epilepsy. The prevention and treatment of epilepsy. The commonly Used Antiepileptic Medicine And Their Main Side Effects. The emergency rescue of epileptic state. To be familiar with: The classification of epilepsy. To understand: The etiology and prognosis of epilepsy.

Chapter 6. Parkinsonism To master: The clinical manifestation and diagnosis of Parkinsonism. To be familiar with: The treatment of Parkinsonism. To understand: The etiology and pathology of Parkinsonism

Chapter 7. Raised Intracranial Pressure To master The clinical manifestation of raised ICP. To be familiar with The physiopathology and consequnce of raised ICP. The treatment of raised ICP. To understand The differential diagnosis of myasthenia gravis. 372

Chapter 8. Myasthenia Gravis To master The clinical manifestation of myasthenia gravis. To be familiar with The treatment of myasthenia gravis and diagnosis of myasthenia gravis crisis. To understand The etiology and pathogenesis of myasthenia gravis.

Chapter 9. Psychiatry overview To master The main neurotransmitter systems involved in mental function. To be familiar with The overall biological mechanism of psychiatric disease. To understand The history and development of psychiatry in the world and China.

Chapter 10. General Psychopathology To master The conceptions of abnormal symptom of perception, thought and mood. To be familiar with The conception of psychopathological phenomena, symptoms of abnormal states of mind including consciousness, memory, intelligence and personality. To understand The general methods of history taking, mental state examination and cognitive testing.

Chapter 11. Psychiatry of Old Age To master 1. The diagnosis methods and principle of Alzheimer's disease. 2. The diagnosis methods and principle of Vascular dementia. To be familiar with 1. The diagnosis methods and principle of Dementia with Lewy bodies and other dementias. 2. The process and development of physiology of Alzheimer's disease. 373

3. The principles of psychotropic medication of Alzheimer's disease. To understand 1. Assessment of cause and severity of dementia (cognitive impairment and behavioral abnormalities). 2. Assessment of deficits in function and need for care (dependency). 3. Provision of treatment and care appropriate to the needs which have been identified.

Chapter 12. Schizophrenia To master 1. The symptoms and the clinical manifestation of schizophrenia sub-types. 2. The management principle of schizophrenia and main biological mechanisms of antipsychotics. To be familiar with 1. The diagnostic Criteria (DSM IV) for schizophrenia. 2. The differentiate diagnosis of schizophrenia. 3. The relevant factors of prognosis of schizophrenia. To understand 1. The historical perspective of schizophrenia. 2. The epidemiology and etiology of schizophrenia including environment factors and genetic factors.

Chapter 13. Mood Disorders To master 1. The definition of terminology of mood disorder such as dysthymia and cyclothymia. 2. The clinical sub-types of mood disorder and their manifestation. 3. The management principle of mood disorder. 4. The main biological mechanisms of antidpressants. To be familiar with 1. The diagnostic Criteria (DSM IV) for mood disorder. 2. The differentiate diagnosis of mood disorder. 3. The relevant factors of prognosis of mood disorder. To understand

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1. The historical perspective of mood disorder. 2. The epidemiology and aetiology of mood disorder.

Chapter 14. Neurosis To master 1. The definition and diagnostic criteria of anxiety disorders. 2. The definition and diagnostic criteria of obsessive compulsive disorder. To be familiar with 1. The main diagnostic point, the principle of prevention and treatment for phobia neurosis and hysteria. 2. The diagnosis and the management principle of somatoform disorders. To understand The clinical presentation, diagnosis and management principle of stress related disorders.

Ⅲ. Practice Requirements 1. Be Familiar with the skills of making neurological examination. 2. Be Familiar with the basic knowledge of following auxiliary examinations which are important in diagnosis of neurological diseases, lumbar puncture, TCD (transcranial doppler sonography), EEG (electroencephalogram), EMG (electromyogram), cranial CT scan and MR image. 3. Be Familiar with the common clinical manifestations of the mental disorders.

Ⅳ. Ability Training Requirements Upon completion of this subject, students will be able to: 1. Master the skill of collecting case history of Neurologic and Psychiatric diseases and be able to write the medical records of inpatient completely and timely. 2. Master the skill of making neurological examination and lumbar puncture. 3. Master the clinical significance of a series of auxiliary examination report, including CSF test, TCD, EEG, EMG, cranial CT scan and MR image. 4. Master the diagnoses and conventional treatment of common diseases of Neurological system, such as acute cerebrovascular disease, epilepsy, Parkinson disease, intracranial infection, Bell's palsy. 375

5. Based on the observations of clerkship faculty and/or the clerkship director during patient rounds, case presentations and small group discussions, the student will demonstrate knowledge in the following core areas: 1) Mental illnesses include major depression, dysthymic disorder, bipolar disorder, generalized anxiety disorder, panic disorder, social phobia, obsessive-compulsive disorder, substance and alcohol abuse, schizophrenia/psychoses, dementia and deliriums and somatoform disorders. 2) Demonstrate and understand the use of DSM – IV. 3) Psychopharmacology include the usage of antidepressants, antipsychotics, anxiolytics and mood stabilizing agents in treating the mentally illnesses. 6. During discussions with faculty, the student will demonstrate an analysis of the role of the following in the comprehensive evaluation and management of a psychiatric patient: 1) a. The co-morbidity of mental, neurological and medical illnesses. 2) b. The use of laboratory tests and various types of scans (CT, PET, MRI, etc.) to evaluate mental illness or ongoing monitoring of medications. Ⅴ. Hours Distribution Content Lecture times Lab 1. General Introduction 6 9 2. Peripheral Nerve disease 2 3. Spinal Cord Disease 4 4. Cerebrovascular Disease 6 5. Epilepsy 3 6. Parkinson Disease 1 7. Raised Intracranial Pressure 2 8. Myasthenia Gravis 2 9. Psychiatry overview 2 10. General Psychopathology 2 3 11. Psychiatry of Old Age 2 12. Schizophrenia 3 13. Mood Disorders 3 14. Neurosis 2

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Ⅵ. Assessment Quizzes 20% Final Test 80% Total 100%

Ⅶ. Textbook and references Text Book: 1. Text Books On Clinical Medicine For International Students - NEUROLOGY 2. Text Books On Clinical Medicine For International Students - PSYCHIATRY Reference Books: ADAMS AND VICTOR’S PRINCIPLES OF NEUROLOGY (8th Edition)

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Pediatrics

Credits: 5 Total hours: 88 Lectures hours: 64 Experiment hours 24 Grade: 5th Semester: 1 Li Jiang Hong-Li Tang Li-Xing Qiao Li-Ping Yin Quan Wen Li-Juan Qian Compilers: Huan Zhu Hai-Ying Wang Zhong-Tang Li Zhao-Kui Zhu Han Li Ji-Nan Han Email: [email protected] Preface Pediatrics is a comprehensive medical science. Its main task is to study the growth and development of children of all ages, health care, diagnosis, treatment and the prevention of diseases. Objectives and requirements: Pediatrics teaching should attach importance to the cultivation of knowledge and ability, to enable students to master the system of pediatrics theoretical knowledge, with a strong clinical thinking and analytical problem-solving skills. Focus on linking theory with practice in the teaching work, the exact concept. Introduce new medical progress, home and abroad to reflect the level of modern pediatrics. Culture methods: Pediatric teaching process is divided into classroom teaching and clinical practice.Through the practice, students are familiar with the clinical environment and students’ clinical practice ability can be trained.

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Ⅰ.Preamble and Objectives This course is a clinical medical profession that requires a major professional basic course.Pediatrics is the study of childhood growth rule, nutrition, health care and other basic medicine and disease prevention and control of clinical medical science. Its service object is a physical and mental development of children from the the beginning of fetal period to the end of adolescence stage. The children in anatomy, physiology and psychology, and other aspects are constantly in the process of growth and development.So, in the onset and development of diseases and prevention, various aspects of different age stages have different characteristics. The task of Pediatrics is to improve children's constitution, reduce child morbidity and mortality and Secure children's health by improving their physical, intelligence, psychological behavior and social adaptation and so on. Other tasks include research conduction, protection of children and helping to make their potential fully developed.

Ⅱ.Contents of the Course and Requirements Chapter 1. Introduction to Pediatrics and Principles of child health care To master To master the age group distribution during childhood and principles of child health care. To be familiar with To be familiar with basic and clinical characteristics of pediatrics. To understand To understand the mission and scope of pediatrics. To understand the development and major achievements of child health care in our country.

Chapter 2. Growth and Development To master To master the rules of growth and development. To master indicators of physical growth (the variation, how to calculate and normal values).To master the laws of pediatric neuropsychological development To understand To understand the factors influencing growth and development.To understand developmental processes of the reproductive system in children.To understand the characteristics of adolescent physical growth. 379

Chapter 3. Nutrition and Nutritional Disorders 1. Basic knowledge of pediatric nutrition To understand 1. To understand nutritional requirements of children(nutrients and Reference Intakes). 2. To understand the development of digestive function. 3. To understand the relationship between digestive function and nutrition. 2. Infant feeding To master 1. To master the composition and characteristics of breast milk. 2. To master the benefits of breastfeeding. 3. To master measures which may assure the success of breastfeeding.To master the introduction and the rules of supplementary food. To be familiar with To be familiar with the importance of reasonable feeding.To be familiar with how to estimate the amount that the infant need. To understand To understand the synthesis and secretion of milk.To understand the method of artificial feeding. 3. Nutritional Rickets of Vitamin D deficiency To master 1. To master the definition of this disease. 2. To master the treatment and prevention of this disease. 3. To master the etiology of Nutritional Rickets of Vitamin D deficiency.To master Clinical manifestations(stages, changes of skeleton). To be familiar with To be familiar with Pathogenesis and pathology. To understand To understand the differential diagnosis.To understand metabolism and physiological function of Vitamin D. To understand the source of Vitamin D. 4. Tetany of VD deficiency To master 1. To master the clinical manifestation(symptoms and physical examinations ). 2. To master the diagnosis,treatment and prevention of this disease. 380

To be familiar with To be familiar with the etiology of this disorder.To know the relationship between parathyroid function and Vitamin D deficiency. To understand To understand how to make Differential Diagnosis 5. Protein-energy malnutrition To master 1. To master the definition. 2. To master the pathophysiology of malnutrition and its relationship with clinical manifestation. 3. To master typical clinical manifestations and standard of diagnosis. 4. To master the treatment of malnutrition. To be familiar with To be familiar with the etiology of this disorder. To understand To understand the prevention of this disease.

Chapter 4. Neonate and Neonatal Disease 1. Summary To master To master the neonatal classification. To be familiar with To be familiar with the range and importance of neonatology and perinatology. 2. Characteristics and nursing of normal full-term and preterm infants To master 1. To master the appearance and characteristic of normal full-term and preterm infants. 2. To master some common special physiological condition in neonatal period. To be familiar with To be familiar with anatomical physiology characteristic of normal full-term and preterm infants. To be familiar with the full moon and premature infant nursing principles. To understand To understand the clinical characteristics of large for gestational age and small for gestational age. 3. Hypoxia ischemic encephalopathy(HIE) 381

To master To master the clinical manifestations,diagnosis and treatment. To be familiar with To be familiar with the etiology and mechanism of HIE. To understand To understand the prognosis and prevention of HIE. 4. Meconium aspiration syndrome(MAS) To master To master the clinical manifestations and diagnosis of MAS. To be familiar with To be familiar with definition,etiology and pathophysiology. To be familiar with treatment principle of MAS. 5. Respiratory distress syndrome(RDS) To master To master the clinical manifestations,differential diagnosis and treatment principle. To understand To understand the causes and pathogenesis of RDS. 6. Jaundice of the newborn To master To master the identification of physiological and pathological jaundice. To be familiar with To be familiar with bilirubin metabolism characteristics of infants.To be familiar with the common causes and characteristics of pathological jaundice. 7. Neonatal hemolytic disease To master To master the clinical manifestations,complications and diagnosis of ABO hemolytic disease and Rh hemolytic disease. To be familiar with To be familiar with the etiology and pathogenesis. To be familiar with the treatment. To understand To understand the definition and general incidence of neonatal hemolytic disease. 8. Neonatal infectious diseases 382

To be familiar with To be familiar with the routes of infection and pathogenic bacteria. To understand To understand the definition of neonatal infectious diseases. Neonatal sepsis To master To master clinical manifestations,diagnosis. To be familiar with To be familiar with the treatment principle. To understand To understand the etiology and mechanisms. Neonatal infectious pneumonia To master To master the clinical characteristics and diagnosis. To be familiar with To be familiar with the treatment principle. To understand To understand the general situation of neonatal infectious pneumonia.To understand the causes of neonatal infectious pneumonia.

Chapter 5. Hereditary and Metabolic Diseases Down syndrome To master To master the clinical features and diagnosis of trisomy 21 syndrome. To be familiar with To be familiar with the cytogenetic characteristics of trisomy 21 syndrome. To understand To understand genetic counseling and treatment of this syndrome. Phenylketonuria To master To master the Clinical manifestations and diagnosis of phenylketonuria. To be familiar with 383

To be familiar with the treatment of phenylketonuria. To understand To understand the etiology,the mode of inheritance and pathogenesis of phenylketonuria.

Chapter 6. Immunological Disease Kawasaki disease (skin and mucosa,lymph node syndrome) To master To master its diagnosis standard and be familiar with its differential diagnosis. To be familiar with To be familiar with the clinical manifestations and treatment principle. To understand To understand the causes and pathological staging of kawasaki disease

Chapter 7. Infectious Diseases 1. Virus infection Measles To master 1. To master the early diagnosis and the typical clinical of measles. 2. To master the differential diagnosis points between measles and other common eruption disease. 3. To master the control principles and methods of measles To be familiar with 1. To be familiar with other types of clinical manifestations of measles. 2. To be familiar with the common complications. 2. Tuberculosis Summary To master To master the diagnosis control key points, the standard of the judgment and clinical significance of tuberculin test results. To be familiar with To be familiar with pediatric tuberculosis treatment principles and preventive measures. To understand 384

To understand the etiology and pathogenesis of tuberculosis. The original hairstyle tuberculosis To master 1. To master the definition of original hairstyle tuberculosis. 2. To master the clinical manifestations,treatment and outcome of the original hairstyle tuberculosis (primary syndrome, bronchial lymph node tuberculosis). To understand To understand its pathological changes. Tuberculous meningitis To master To master the clinical manifestation, diagnosis, differential diagnosis and treatment of tuberculous meningitis. To understand To understand the importance of the early diagnosis of tuberculous meningitis.

Chapter 8. Digestive System Disease 1. Characteristics of pediatric liquid equilibrium and fluid therapy To master 1. To master the clinical manifestations of different degree and quality of dehydration. 2. To master the calculation principle of fluid therapy. 3. To master the fluid therapy of infantile acute diarrhea. To be familiar with 1. To be familiar with the characteristics of liquid equilibrium. 2. To be familiar with the definition and pathophysiology of fluid,electrolyte and acid-base disorders. 3. To be familiar with the commonly used solution composition and application methods. 2. Infantile diarrhea To master To master the etiology, pathogenesis and clinical manifestations of infantile diarrhea. To be familiar with To be familiar with the differential diagnosis of infantile diarrhea. To understand 385

To understand the prevention of infantile diarrhea.

Chapter 9. Disease of the Respiratory System 1. The anatomical and physiological characteristics of respiratory system in children To be familiar with To benfamiliar with the anatomical and physiological characteristics of respiratory system in children. 2. Acute respiratory infection To master 1. To master the pathogeny,clinical characteristics,diagnosis and treatment of AURI, acute bronchitis,bronchiolitis. 2. To master the clinical characteristics of 2 special kinds of AURI. 3. To master the sort of pneumonia. 4. To master the pathogeny,pathophysiology,clinical characteristics,diagnosis and treatment of bronchopneumonia. 5. To master the clinical characteristics of pneumonia induced by different pathogens. To be familiar with To be familiar with the clinical characteristics,diagnosis and emergency treatment of febrile seizures.

Chapter 10. Cardiovascular System diseases 1. normal cardiovascular anatomy and physiology and inspection methods 1. To be familiar with the characteristics of normal cardiovascular anatomy and physiology. 2. To understand the inspection methods of Children cardiovascular diseases. 2. Congenital heart disease To master To master the etiology and classification of congenital heart disease. To master the pathophysiology, hemodynamic, clinical manifestations, complications and diagnostic of several common congenital heart disease:atrial septal defect, ventricular septal defect,patent ductus arteriosus and tetralogy of Fallot. To be familiar with To be familiar with the principles of treatment of the above mentioned congenital heart disease. 386

To understand To understand the diagnosis,physical examination,and special examinations of congenital heart.

Chapter 11. Urinary System Diseases 1. Pediatric urinary system anatomy and physiology To be familiar with To be familiar with the characteristics of the pediatric urinary system anatomy and physiology. 2. Glomerular disease To master the clinical Acute glomerulonephritis To master To master the typical and serious manifestations,laboratory tests,course of disease,treatment and prognosis of acute post-streptococcal glomerulonephritis. To understand To understand the etiology and pathogenesis of acute post-streptococcal glomerulonephritis.To understand the differential diagnosis of acute post-streptococcal glomerulonephritis. Nephrotic syndrome To master To master the clinical manifestations and diagnostic criteria for the simple nephropathy and nephritis nephropathy. To master the treatment of nephrotic syndrome. To be familiar with To be familiar with the four characteristics and pathophysiology of nephrotic syndrome.To be familiar with the common complications of nephrotic syndrome. To understand To understand the pathological classification of nephrotic syndrome.To understand the relationship between the classification and its clinical.

Chapter 12. Hematopoietic System Disease Pediatric hematopoietic and blood picture characteristics To be familiar with 1. To be familiar with the normal pediatric hematopoietic characteristics. 2. To be familiar with the normal children blood picture. 387

Pediatric anemia To master 1. To master the definition of pediatric anemia. 2. To master the anemia diagnosis standard and anemic shape classification that the world health organization and Chinese pediatric hematology meeting ruled. 3. To master etiology,pathogenesis,clinical manifestation,diagnosis,treatment and prevention of nutritional iron deficiency anemia and megaloblastic anemia.

Chapter 13. Disease of the Neuromuscular System Purulent meningitis To master To master it’s clinical characteristics,especially in infants.To master the difference between the normal and abnormal cerebrospinal fluid. To master its therapeutic principles. To be familiar with To be familiar with its pathogenesis To understand To understand the complications.To understand its pathological changes.

Chapter 14. Endocrine Diseases Congenital hypothyroidism syndrome To master 1. To master the clinical manifestations of the disease. 2. To master newborn screening method. 3. To master the diagnosis and be familiar with the treatment principles of this disease. To be familiar with To be familiar with its laboratory findings. To understand 1. To understand the physiological function of the thyroid hormone. 2. To understand the classification and the etiology of congenital hypothyroidism.

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Ⅲ.Practice Requirements The aim of the clinical practice in Pediatrics is to deepen the understanding of the knowledge of Pediatrics,to implement what is learned in class into the medical practice. Through the practice, the intern should master the case history collecting, physical examinations, medical record writing and the basic operation skills of Pediatrics.The intern should also master the diagnosis,treatment and prevention of the commonly occurring pediatric diseases.At the same time of learning the intern should cultivate the independent learning and research abilities,the sense of duty,the creativity and humanism. 1. Be familiar with the working procedure and the regulations of Pediatrics;observe the discipline and the rules of working. 2. Master the child’s growth and development law,the anatomical and physiological characteristics of every stage of child’s development,and the guidance for the child’s health care. 3. Master the diagnosis,differential diagnosis and the treatment principles of the common diseases of the Pediatrics. 4. Master the applications,dosage and the side effects of commonly used medicines. 5. Master the basic theory of water, electrolyte and acid-base equilibrium of the child;master the skill of liquid therapy. 6. Master the history taking,physical examination and the writing of cases records and the course of disease of the hospitalized patients. 7. Master the common diagnostic and treatment operation techniques of Pediatrics. 8. Master the diagnosis,differential diagnosis and the treatment principles of the critical diseases like poison,convulsion,high fever,abdominal pain,shock,dyspnea and sudden cardiac arrest.

Ⅳ.Ability Training Requirements Ability cultivation of clinical analysis and thinking through the analysis of specific cases,to develop clinical diagnosis thinking ability of common diseases in the pediatric medical areas. Self-study ability training through teaching of the course, to cultivate and improve the student knowledge of sorting, generalization, the digestion and absorption ability around the classroom teaching 389

content,reading reference books and material, self expansion in the field of knowledge ability. The cultivation of the ability of expression: mainly through the case analysis, express their clinical diagnosis thinking and steps of ability clearly and neatly.

Ⅴ. Hours Distribution Content Lecture Discuss Lab 64 24 The Scope of Pediatrics 6 7 Childhood Nutrition and Nutritional Disorders 8 3 The Newborn Infant 10 4 Genetic and Metabolic Diseases 2 Immunodeficiency and Rheumatic Diseases 2 Infectious Diseases 6 Gastrointestinal Tract 6 3 Diseases of the Respiratory System 6 4 Cardiovascular Diseases 6 3 Kidney and Urinary Disorders 4 Hematologic Disorders 2 Neurologic and Muscular Disorders 2 Disease of the Endocrine 2

Ⅵ. Assessment Coursework 10% Attendance and Performance 10% Quizzes 10% Clinical Clerkship 10% Final Test 60% Total 100%

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Ⅶ. Textbook and references Text book 1. Nelson textbook of pediatrics（19th EDITION）.Robert M. Kliegman，Bonita M.D. Stanton,Joseph St. Geme,Nina F Schor PhD,Richard E. Behrman. Saunders.2011.06. 2. Textbook of Pediatrics.Chief Editors Wang Weiping.Zhu Jianxing. PEOPLE’S MEDICAL PUBLISHING HOUSE,2007. Reference books 1. Rudolph’s Pediatrics.（21th Edition）.Colin D. Rudolph,Abraham M. Rudolph,Margaret K.Hostetter,George Lister,Norman J. Siegel. McGraw-Hill companies.2003. 2. Current Pediatric Diagnosis & Tretment（17th Edition）.William W. Han,Jr. Myron J. Levin Judith M. Sondheimer Robin R.Deterding. McGraw-Hill companies.2005.

391

Ophthalmology

Credits: 2.5 Total hours: 48 Lectures hours: 32 Experiment Hours 16 Grade: 5th Semester: 1 Jie Luan Compiler: Email: [email protected]

Preface Ophthalmology is a clinical subject about eye diseases. It’s as important as other clinic subjects. Why should we learn ophthalmology? Firstly, about 90% information is obtained from eyes. The eyes are important to our common life and work. Secondly, there are many systemic diseases, such as hypertension, diabetes mellitus, which could have manifestations in the eye, and these are helpful for physicians to make diagnosis from those manifestations.

Ⅰ. Preamble and Objectives The course highlights basic knowledge of common eye diseases, including symptoms, signs, diagnosis, treatment, course and outcome.

Ⅱ. Contents and Requirements Chapter 1. Diseases of Eyelid To master To master signs, symptoms, and management of hordeolum, chalazion. To be familiar with To be familiar with the signs, symptoms, and management of blepharitis.

Chapter 2. Diseases of Lacrimal Apparatus To master

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To master signs, symptoms, and management of diseases of the lacrimal drainage system, including Congenital obstruction and Acquired obstruction of the lacrimal sac and duct.

Chapter 3. Diseases of Conjunctiva To master To master signs, symptoms, diagnosis, and management of conjunctivitis, especially trachoma. To be familiar with To be familiar with the differential diagnosis of conjunctivitis.

Chapter 4. Ocular Surfaces Diseases To master 1. To master the definition of ocular surfaces. 2. To master the signs, symptoms, and management of dry eye syndrome. To be familiar with To be familiar with the main types of ocular surfaces diseases and their treatment principles. To understand To understand the research development about ocular surfaces diseases .

Chapter 5. Diseases of Cornea To master 1. To master the signs, symptoms, and management of keratitis. 2. To master the signs, symptoms, and management of bacterial ,fungal and herpes simplex keratitis and corneal ulcers. To be familiar with To be familiar with the signs, symptoms, and management of keratoconus, acanthamoeba keratitis. To understand To understand the signs, symptoms, and management of Mooren’s ulcer, superior limbic keratoconjunctivitis

Chapter 6. Diseases of Lens To master 393

1. To master the classification, signs, symptoms, diagnosis and management of age-related cataract. 2. To master the clinical staging of cortical cataract. To be familiar with To be familiar with the classification and management of cataract. To understand To understand ectopia and dislocation of lens.

Chapter 7. Glaucoma To master To master the signs, symptoms, clinical staging,diagnosis, and management of acute angle-closure glaucoma. To be familiar with To be familiar with the clinical manifestation,diagnosis and management of primary open-angle glaucoma. To understand To understand the pathologic mechanisms of glaucoma.

Chapter 8. Diseases of Uvea To master To master the signs, symptoms, complications and management of uveitis, especially the anterior uveitis and sympathetic ophthalmia. To be familiar with To be familiar with the signs, symptoms, and management of intermediate uveitis, posterior uveitis and panuveitis To understand 1. To understand the complexity of uveitis and the relationship between systemic diseases and uveitis. 2. To understand the congenital abnormality of uvea.

Chapter 9. Diseases of Retina To master 394

1. To master the signs of retinal pathologic, including cellular edema, retinal exudates, retinal hemorrhage and neovascularization. 2. To master the fundus signs of central retinal artery occlusion, central retinal vein occlusion, diabetic retinopathy, central serous chorioretinopathy, age-related macular degeneration, retinitis pigmentosa. 3. To master the causes, signs, symptoms, and management of rhegmatogenous retinal detachment. To be familiar with To be familiar with the management of central retinal artery occlusion, central retinal vein occlusion, diabetic retinopathy, central serous chorioretinopathy, age-related macular degeneration, retinitis pigmentosa. To understand To understand the examination of fundus fluorescein angiography.

Chapter 10. Optical Nerve Diseases To master 1. To master the visual fields of sella turcica or pituitary diseases. 2. To master the classification of optic atrophy. 3. To master the differential diagnosis of papilledema and papillitis. To be familiar with To be familiar with the visual fields of papilledema, papillitis and anteroir ischemic optic neurapathy. To understand To understand the management of papilledema and papillitis.

Chapter 11. Optics of the Eye To master To master the definition, signs, symptoms, and management of myopia, hyperopia, astigmatism, anisometropia and presbyopia. To be familiar with 1. To bebfamiliar with the basic optical structure of the eye refraction system. 2. To be familiar with the accommodation mechanism of emmetropia. 395

To understand To understand the management principle of glasses, contact lenses and corneal refractive surgery.

Chapter 12. Strabismus and Amblyosis To master 1. To master the anatomy of the extraocular muscles(including the anatomy, nerve supply; blood supply). 2. To master the definition, etiology, signs, symptom and management of amblyopia. 3. To master the definition of strabismus and the functions of extraocular muscles. 4. To master the classification of the esotropia, and to master the symptoms and management of different kinds of esotropia To be familiar with 1. To be familiar with the sensory changes of strabismus. 2. To be familiar with the examination, management of strabismus. 3. To be familiar with pseudoesotropia

Chapter 13. Ocular Trauma To master To master the emergency management of chemical eye injury. To master the emergency management of penetrating eye injuries. To be familiar with To be familiar with the processing management principle of hyphema. To be familiar with the examination and management principle of all types of ocular trauma. To understand To understand the manifestations, management and prevention of ocular blunt trauma, ocular penetrating injury, intraocular foreign body injury .

Ⅲ. Practice Requirements To master the construction of eyeball and appendages of the eye. 1. To master the general examination of external eye. 2. To master slit lamp examination. 3. To master ocular motility examination. 396

4. To master the examination of fundus and to master what the normal fundus is. 5. To master the principle of optometry and matchment for glasses. To be familiar with pupillary examination and visual fields testing. To understand 1. To understand examination of gonioscopy and scotopia. 2. To understand the mechanism of tonometry.

Ⅳ.Ability Training Requirements Upon completion of this subject, students will be able to master the general examination of Ophthalmology and the use of common instruments, to completely draw pictures of eyeball and fundus.

Ⅴ.Hours Distribution Content Lecture Discuss Lab 32 16 Diseases of Eyelid 2 Diseases of Lacrimal Apparatus 2 Diseases of Conjunctiva 2 Ocular Surfaces Diseases 3 Diseases of Cornea 3 Diseases of Lens 3 Glaucoma 3 Diseases of Uvea 3 Diseases of Retina 2 Optical Nerve Diseases 2 Optics of the Eye 2 Strabismus and Amblyosis 3 Ocular Trauma 2

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Serial number Practice content (Lab) Hours 1 Anatomy and physiologic function of eye. 4 2 General examination of eye. 4 3 Examination of fundus 4 4 Examination with slit lamp microscope and optometry 4

Ⅵ.Assessment Quizzes (middle-term Test) 50% Final Test 50% Total 100%

Ⅶ.Textbook and references Text Book Zhang Lin. Ophthalmology, Deans Office of Xi’an Jiaotong University, November 2004 Reference Books General Ophthalmology, by D Vaughan (editor), T Asbury (editor), by Lange Maruzen Journals 1. Ophthalmology; 2. American Journal of Ophthalmology; 3. British Journal of Ophthalmology.

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Infectious Diseases

Credits: 2.5 Total hours: 48 Lectures hours: 32 Experiment Hours 16 Grade: 5th Semester: 1 Hong Ji Yong-Fen Yang Qin-Fang Xiong Compilers: Zhi-Liang Hu Yan-Dan Zhong Email: [email protected]

Preface Despite enormous advances in diagnosis, treatment, and prevention during the twentieth century, physicians caring for patients with infectious diseases today must cope with extraordinary new challenges, including a never ending deluge of new information, the rapid evolution of the microorganisms responsible for these diseases, and formidable time and cost constraints. Infectious diseases is an important course of clinical medicine. It belongs to internal medicine system and is closely associated with microbiology, parasitology, immunology, epidemiology, internal medicine, pediatrics and so on. However, it has some characters. Teaching of infectious diseases should make the students master the theoretical knowledge and essential clinical techniques of infectious diseases. That will be of benefit to their medical work after graduation. This guidebook is intended for the use of foreign medical students interested in studying clinical medicine. The requirement intensity (strength) of infectious diseases guidebook is generally divided into the following 3 levels, high (to master), moderate (to be familiar with), and low (to understand) in this guidebook. The intention of this new guidebook is not only to confer information to medical students, but also to incite teachers and students to take part in the further development of medical education at Southeast University.

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Ⅰ. Preamble and Objectives Infectious disease is the science that investigates the onset, development, spread, therapy and prevention of infectious diseases. The teaching of infectious diseases should focus on cultivating the capability to analyze clinical problems correctly, the capability of self-study and self-working. The students should learn how to use the essential knowledge, clinical knowledge like clinical manifestation and therapeutic principle together to solve the clinical problems. They should also learn the regularity of infectious diseases. Reference of teaching time, Infectious diseases teaching can be divided into two phases, including teaching the theoretical knowledge in class and clinical practice. The total time is 48 teaching periods. Teaching in class and clinical probation share 32 and 16 teaching periods respectively.

Ⅱ. Contents and Requirements Chapter 1. General introduction of infectious diseases To master To master the definition of infection and infectious diseases, the five types of manifestation during infection, the four principle features, the clinical feature, the laboratory examination, diagnosis and therapy of infectious diseases. To be familiar with To be familiar with the three essential steps of epidemiology of infectious diseases, diagnosis and prevention of infectious diseases. To understand To understand the role of pathogen in the process of infection, the role of immune response in the process of infection, the onset and development of infectious diseases, the pathogenesis of the injury of the tissue and the important pathological change.

Chapter 2. Viral Infection 1. Viral hepatitis To master To master the features of the pathogen, the system of antigen and antibody, the clinical significance of viral nucleic acid, the clinical manifestation of each type of viral hepatitis, the diagnosis and differential diagnosis of viral hepatitis, the essential therapeutic principles and the preventive 400

measure of hepatitis A and hepatitis B. To be familiar with To be familiar with the epidemiology, the pathogenesis and pathological change of viral hepatitis. To understand To understand the pathological feature and the prognosis of viral hepatitis. 2. Epidemic encephalitis B To master To master the clinical manifestation, laboratory examination, evidence of diagnosis and therapy of Epidemic encephalitis B. To be familiar with To be familiar with the pathogenesis, feather and differential diagnosis of epidemiology of Epidemic encephalitis B. To understand To understand the etiology including the feature of the virus, prognosis and sequela symptoms in convalescent period of Epidemic encephalitis B. 3. Hemorrhage fever with renal syndrome To master To master the clinical manifestation, laboratory findings, evidence of diagnosis and therapy of hemorrhage fever with renal syndrome. To be familiar with To be familiar with the epidemiology and pathogenesis of hemorrhage fever with renal syndrome. To understand To understand the feature of Hantan virus and the method of prevention of hemorrhage fever with renal syndrome. 4. Acquired immunodeficiency syndrome (AIDS) To master To master the epidemiology, the clinical manifestation and the diagnostic methods of AIDS. To be familiar with To be familiar with the pathogenesis, the high risk population, the therapeutic principle and the preventive measures of AIDS. To understand To understand the features of AIDS’ pathogen. HIV is a kind of retrovirus and the morphous and 401

gene structure of HIV. 5. Rabies To master To master the epidemiology, clinical manifestation, evidence of diagnosis and the preventive measures of rabies. To be familiar with To be familiar with the features of pathogen, laboratory findings and the therapeutic principle of rabies. To understand To understand the pathogenesis of rabies.

Chapter 3. Bacterial Infection 1. Epidemic cerebrospinal meningitis To master To master the clinical manifestation, the diagnostic evidence and the etiologic therapy of epidemic cerebrospinal meningitis. To be familiar with To be familiar with the epidemiology, the relationship between pathogenesis and clinical manifestation of epidemic cerebrospinal meningitis. To understand To understand the features of Neisseria meningitdis and the principle of preventive measures of epidemic cerebrospinal meningitis. 2. Typhoid fever To master To master the pathogenesis, the relationship between the pathological features and clinical manifestations, the clinical manifestations in 4 phases of the typical type, the principle complications, the evidence for diagnosis and the differential diagnosis and pathogenic treatment of typhoid fever. To be familiar with To be familiar with the epidemiology, relapse and recrudescence of typhoid fever. To understand To understand the feature of Bacterium typhi including the living characters, resistance, antigen 402

and the principles of prevention. 3. Shigellosis To master 1. To master the relationship among the pathogenesis, pathological changes and clinical manifestations. 2. To master the pathological background of the clinical manifestations like fever, diarrhea, mucous stool with bloody pus, tenesmus and so on. 3. To master the clinical manifestation, diagnosis and differential diagnosis of Shigellosis. To be familiar with To be familiar with the epidemiology of Shigellosis and the therapeutic principle of Shigellosis. To understand To understand the features of pathogen and the principles of preventive measures of Shigellosis. 4. Cholera To master To master the clinical manifestation, the evidence for diagnosis and differential diagnosis of cholera and therapy of cholera. To be familiar with To be familiar with the feature of etiology, lab test and preventive measure of cholera. To understand To understand the epidemiology of cholera.

Chapter 4. Parasite Infection To master To master the clinical manifestation, the diagnostic evidence and differential diagnosis of malaria and treatment of malaria. To be familiar with To be familiar with the pathogenesis and epidemiology of malaria. To understand To understand the relationship between the life cycles of four plasmodiums, onset of the illness, recrudescence transmission and preventive measures of malaria.

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Ⅲ.Practice Requirements 1. Teach the general introduction of infectious diseases in class, make the students master the essential theories about the characters of infectious diseases, definitions of infectious diseases, the manifestations of infectious process, the epidemic process and influencing factors of infectious diseases, the essential characters and clinical features of infectious diseases, the diagnostic measures and therapy of infectious diseases, the prevention of infectious diseases and so on. The students should master the etiology, epidemiology, pathogenesis, pathological changes, clinical manifestations, laboratory findings, complications, diagnosis, differential diagnosis, treatment and prevention of common infectious diseases through the class teaching. 2. Through class teaching, teaching on probation and practice, the students should learn how to make a summary of a case, find the diagnosis and differential diagnosis, and make a plan of treatment, further examination based on the essential theories of infectious diseases. 3. The students should learn how to collect the illness history, make physical examination, write history report and make an initial diagnosis and therapeutic plan, write the progress notes and master some common medical techniques like lumbar puncture, thoracentesis, abdominal paracentesis, bone marrow aspiration during the probation and practice of infectious diseases.

Ⅳ. Ability Training Requirements Upon completion of this subject, students will be able to: 1. Cultivate the capability of self-study: According to the problems from clinical practice, the teachers would have to guide the students to look up the related reference, journals, and textbook. Teach them the methods of self-study and enhance their capability of self-study. 2. Cultivate the capability of clinical analysis: During the probation and practice of infectious diseases, teach the students how to consider the clinical problems through clinical rounds, case demonstration and case discussion. Try to enhance the students’ capability of clinical analysis. 3. Cultivate the independent capability to deal with clinical problems: During the clinical practice, the students should learn to write the case history, prescribe the medical order, write the case progress note and do some common operations with the guidance of the teachers. The teachers should cultivate their independent capability to deal with clinical problems.

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Ⅴ. Hours Distribution Clinical Content Lecture Discuss Lab Clerkship 32 16 Introduction 4 4 Viral hepatitis 8 4 HFRS 2 Epidemic encephalitis B 2 AIDS 2 Rabies 2 Epidemic cerebrosipinal meningitis 2 Typhoid fever 2 4 Cholera 2 Bacillary dysentery 2 Malaria 2 4

Ⅵ. Assessment Coursework 20% Final Test 80% Total 100%

Ⅶ.Textbook and References Text Book Liu Zhengwen, Zhang Shulin, Lemology, Xian Jiaotong University,2004 Reference Books 1. HARRISON’S Infectious Diseases Seventeenth Edition 2. Cecil MEDICINE 24th Edition Useful web sites 1. www.who.int/en 2. www.aidsinfo.nih.gov/ 3. www.cdcnpin.org/

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Otorhinolaryngology

Credits: 2.5 Total hours: 48 Lectures hours: 32 Experiment Hours 16 Grade: 5th Semester: 2 Sun Bao-Bin Compiler: Email: [email protected] Preface Otorhinolaryngology is the subject of physiology and diseases about ear, nose, throat, head ＆ neck. This outline is helping medical students to grasp the concept of applied anatomy, physiology and common diseases about these organs of human beings. At the same time, this outline is helping medical students to know some frequently used methods and preliminary skills about managing these diseases of ear, nose, throat, head ＆neck.

Ⅰ. Preamble and Objectives Otorhinolaryngology is the specialty which deals with diseases and disorders of the ear, nose, throat, head & neck. As a basic request, the students must understand the concept, category and internal relationship of otorhinolaryngology and master the applied anatomy of the ear, nose, throat, head & neck. As well as to understand the pathogenesis, clinical manifestation, diagnostic methods and therapeutic principle of the disease about the ear, nose, throat, head & neck. The students must familiar be with or master detailed knowledge of scientific rationale for this specialty and correlative clinical specialty.

Ⅱ. Contents and Requirements Chapter 1. Rhinology 1. Applied anatomy and physiology of the nose To master Mastering the important anatomical structures of the nose, the relationship between nasal cavity and paranasal sinus and its clinical significance.

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To be familiar with Familiarizing with the physiological functions of the nose. 2. Examination of nose To master Mastering the correct use of head mirror and nasal speculum. To understand 1) To understand the clinical application of nasal endoscope. 2) To understand the normal appearance of external nose and nasal cavity. 3) To understand the imaging examinations of nose. 3. Acute rhinitis (Common cold) To master Mastering the diagnosis and the treatment of acute rhinitis. 4. Allergic rhinitis To master Mastering the cause, pathogenesis, diagnosis and the treatment of allergic rhinitis. To be familiar with Familiarizing with the lab studies of allergic rhinitis. To understand To understand the preventive method of allergic rhinitis. 5. Sinusitis To master Mastering the diagnosis of chronic suppurative sinusitis and the difference between different types of chronic rhinitis. To be familiar with Familiarizing with the diagnosis and the treatment of acute suppurative sinusitis. To understand To understand the therapeutic methods of chronic sinusitis. 6. Epistaxis To master Mastering the common causes and the management of epistaxis. 7. Cancers of the nose and sinuses To master 407

1. Mastering the clinical manifestations of benign tumors (papilloma, hemangioma and osteoma) and its difference from malignant tumors. 2. Mastering the diagnosis and management of malignant tumors of nasal cavity and paranasal sinus.

Chapter 2. Pharyngology 1. Anatomy of the pharynx To master Mastering the important anatomical structures of the nasopharynx, oropharynx and laryngopharynx. To be familiar with 1. Familiarizing with the structural features of the pharyngeal lymphoid ring and the anatomy of parapharyngeal space. 2. Familiarizing with the physiological functions of the pharynx. 2.Examination of the pharynx To master 1. Mastering the normal appearance of nasopharynx, oropharynx and laryngopharynx. Mastering the examination methods of oropharynx. 2. Mastering the correct use of tongue depressor. ] To understand To understand the examination methods of nasopharynx and laryngopharynx. 3.Acute infective pharyngitis To be familiar with Familiarizing with the diagnosis and treatment of acute pharyngitis. 4.Chronic pharyngitis To be familiar with Familiarizing with the diagnosis and treatment of chronic pharyngitis. 5. Acute tonsillitis To master Mastering the clinical manifestations, management of acute tonsillitis and the difference between pharyngitis and diphtheria. To understand 408

To understand its complications. 6. Adenoidal hypertrophy To master Mastering the clinical manifestations and management of adenoidal hypertrophy. 7. Chronic tonsillitis To master 1. Mastering the clinical manifestations of chronic tonsillitis. 2. Mastering the surgical indications and contraindications of tonsillectomy. To be familiar with Familiarizing with the diagnosis and treatment of chronic tonsillitis . 8.Pharyngeal abscess To be familiar with Familiarizing with the diagnosis and treatment of peritonsillar abscess. To understand To understand the clinical manifestations and management of retropharyngeal and parapharyngeal abscess. 9. Neoplasms of the pharynx To master Mastering the clinical manifestations, diagnosis and treatment of nasopharyngeal carcinoma. To be familiar with Familiarizing with the diagnosis and treatment of nasopharyngeal fibroangioma.

Chapter 3. Laryngology 1. Applied anatomy and physiology of the larynx To be familiar with 1. Familiarizing with the main cartilage framework of the larynx, laryngeal muscles, structure of the laryngeal cavity , nerves and lymph nodes of the larynx. 2. Familiarizing with the anatomical features and clinical significance of the larynx in children. 3. Familiarizing with the physiological functions of the larynx. 2. Examination of the larynx To be familiar with Familiarizing with indirect laryngoscopy. 409

To understand To understand direct laryngoscopy, fibrolaryngoscopy, microlaryngoscopy, strobolaryngoscopy, investigation methods of laryngeal functions and imaging studies of the larynx. 3. Congenital malformation of larynx To understand Knowing the definition of laryngeal webs and laryhngomalacia. 4. Acute laryngitis To be familiar with Familiarizing with the clinical manifestations, diagnosis and treatment of acute laryngitis. To understand Knowing the difference of acute laryngitis from laryngotracheobronchitis. 5. Chronic laryngitis To be familiar with To be familiar with Familiarizing with the clinical manifestations, diagnosis and treatment of chronic laryngitis. To understand Knowing the difference of chronic laryngitis from polyp of vocal cord, vocal nodules and hysterical aphonia. To understand Knowing the methods of its prevention and treatment. 6. Acute epiglottitis To master Mastering the clinical manifestations, diagnosis and treatment of acute epiglottitis. 7. Laryngotracheobronchitis(Croup) To understand Knowing the clinical manifestations, diagnosis and treatment of laryngotracheobronchitis. 8. Vocal cord polyp and nodulus To understand knowing their etiologies and management. 9. Vocal cord paralysis To understand Knowing the clinical manifestations, diagnosis and treatment algorithm of laryngeal paralysis. 410

10. laryngeal papilloma To be familiar with Familiarizing with the clinical manifestations, diagnosis and treatment algorithm of laryngeal papilloma. 11. Laryngeal cancer To master Mastering the clinical manifestations, differential diagnosis and management of laryngeal carcinoma. 12. Laryngeal obstruction To master Mastering the etiology, clinical manifestations, differential diagnosis and management of laryngeal obstruction. To be familiar with Familiarizing with the indications, surgical procedures and common complications of tracheotomy. To understand To understand the method of endotracheal intubation. 13. Laryngeal trauma To understand Knowing the diagnosis and treatment of the laryngeal trauma.

Chapter 4. Otology 1. Applied anatomy and physiology of the ear To master Mastering the structure and clinical significance of middle ear. To be familiar with Familiarizing with the physiology of hearing and equilibrium and functions of Eustachian tube. To understand Knowing the anatomical structures of the external and inner ear. 2. Examination of the ear To master Mastering the examination methods of external ear and tympanic membrane. To be familiar with 411

Familiarizing with tuning-fork test. Knowing pure tone audiometry, acoustic impedance, auditory brainstem response audiometry, vestibular function test, and Eustachian tube inflation. To understand Knowing the imaging studies of the ear, pneumatic otoscopy, and myringoscopy. 3. Injury of the tympanic membrane To understand Knowing the clinical manifestations and management of injury of tympanic membrane. 4. Disorders of the external ear To understand 1. Knowing the diagnosis and management of otitis externa and furuncle of the external acoustic meatus. 2. Knowing the clinical manifestations and management of foreign bodies in external acoustic meatus and impacted cerumen. 5. Disorders of the middle ear To master 1. Mastering the etiology, pathogenesis, clinical manifestations and treatment of secretory otitis media. 2. Mastering the etiology, pathology, clinical manifestations and treatment of acute suppurative otitis media. 3. Mastering the etiology, pathology, clinical manifestations and treatment of acute mastoiditis. 4. Mastering the etiology, pathology, clinical manifestations and treatment of chronic suppurative otitis media (mucosal type and cholesteatoma) and difference between the two types. 6. Complications of middle ear infection and mastoiditis To understand Knowing the clinical manifestations and management of postauriclar subperiosteal abscess, labyrinthitis, sigmoid sinus thrombophlebitis, otitic meningitis and otogenic brain abscess. 7. Disorders of the inner ear To be familiar with Familiarizing with the etiology, clinical manifestations, differential diagnosis and treatment of Ménière disease. 8. Hearing loss 412

To be familiar with 1. Familiarizing with the etiology, diagnosis and management of conductive, sensorineural and mixed deafness. 2. Familiarizing with the etiology, clinical feature, prevention and treatment of noised induced hearing loss. 9. Peripheral facial paralysis To understand Knowing the etiology, clinical manifestations, differential diagnosis and treatment of peripheral facial paralysis. 10. Carcinoma of middle ear To understand Knowing the clinical manifestations and treatment of cancer of middle ear.

Chapter 5. Neck 1. Applied anatomy of the neck To be familiar with Familiarizing with the boundary, subregion, main vessel and nerve of neck. To understand Knowing the cervical muscle and lymph node of neck. 2.The neck congenital disease Knowing the clinical manifestations and diagnosis of the thyroglossal cyst, branchial cyst and fistula.

Ⅲ. Practice Requirements Chapter 1. Rhinology To master 1. Mastering applied anatomy. 2. Mastering the examinational methods of nasal cavity and paranasal sinus. 3. Mastering clinical manifestations, diagnosis and treatment of allergic rhinitis and nasal polyps. To understand 1. Understanding the physiology of the nose. 413

2. Understanding the etiology, clinical manifestations, complications and treatment of acute rhinitis and chronic rhinitis. 3. Understanding the methods of puncture and irrigation of maxillary sinus. 4. Understanding the common methods to stop epistaxis. 5. Understanding the therapeutic principles about cancers of the nose and sinuses.

Chapter 2. Pharyngology To master 1. Mastering composition of the pharynx. Mastering space of the pharynx: retropharyngeal and parapharyngeal space. Understanding physiological functions of the pharynx. 2. Mastering the examinational methods of the nasopharynx, oropharynx and laryngopharynx. To understand 1. Understanding the diagnosis and treatment of acute and chronic pharyngitis. 2. Understanding the etiology, clinical manifestations, complications, diagnosis, differential diagnosis and treatment of acute and chronic tonsillitis. Mastering the indications and contraindications of tonsillectomy. 3. Understanding the clinical manifestations of adenoidal hypertrophy. 4. Understanding the diagnosis and treatment of peritonsillar abscess and parapharyngeal abscess. 5. Understanding the etiology, clinical manifestations, diagnosis and treatment of nasopharyngeal carcinoma.

Chapter 3. Laryngology To master 1. Mastering the cartilage framework of the larynx. Mastering the composition of laryngeal muscles. Mastering the structure of laryngeal cavity: supraglottic, glottic and infraglottic portion. Understanding the physiological functions of the larynx. 2. Mastering the examinational methods of indirect laryngoscopy and direct laryngoscopy. Understanding the examinational methods of fibrolaryngoscopy. 3. Mastering the etiology, pathology, clinical manifestations, diagnosis and treatment of acute epiglottitis, acute laryngitis and chronic laryngitis. 4. Mastering the etiology, clinical manifestations, diagnosis, differential diagnosis and treatment 414

of laryngeal obstruction. Mastering surgical indications and procedures of tracheotomy. To understand 1. Understanding the clinical manifestations, diagnosis and treatment of vocal nodules and polyp of vocal cord. 2. Understanding the etiology, pathology, clinical manifestations, diagnosis and treatment of laryngotracheobronchitis (Croup). 3. Understanding the clinical manifestations, diagnosis and treatment of laryngeal paralysis. 4. Understanding the diagnosis and treatment of other benign tumors of the larynx. Mastering the etiology, pathology, staging, clinical manifestations, metastasis, diagnosis, differential diagnosis and treatment of laryngeal carcinoma. 5. Understanding the etiology, clinical manifestations and treatment of contusion, cutting injury and burning injury of the larynx. Understanding the etiology, clinical manifestations, diagnosis and treatment of stenosis of the larynx.

Chapter 4. Otology To master 1. Mastering the applied anatomy of the external, middle, and internal ear. Understanding the physiology of hearing and equilibrium. 2. Mastering the examinational methods of the external ear and tympanic membrane. Understanding the examinational methods of tuning-fork test, pure tone audiometry, acoustic impedance, auditory brainstem response audiometry and vestibular function test. 3. Mastering the etiology, pathology, clinical manifestations, diagnosis, differential diagnosis and treatment of otitis media with effusion. Mastering the etiology, pathology, clinical manifestations and treatment of acute and chronic suppurative otitis media. To understand 1. Understanding the clinical manifestations and management of injury of the tympanic membrane. 2. Understanding the clinical manifestations and management of otitis externa and furuncle of the external acoustic meatus. The clinical manifestations and management of impacted cerumen. 3. Understanding the etiology, diffuse approach, classification, diagnosis and treatment of complications of suppurative otitis media and mastoiditis. 415

4. Understanding the etiology, clinical manifestations, diagnosis, differential diagnosis and treatment of otosclerosis and Ménière disease. 5. Understanding the etiology, clinical features, diagnosis, treatment and prevention of conductive, sensorineural and mixed deafness. 6. Understanding the etiology, pathophysiology, clinical manifestations, diagnosis and treatment of peripheral facial paralysis. 7. Understanding clinical manifestations, diagnosis and treatment of papilloma of the external auditory canal and cancer of the middle ear.

Chapter 5. Neck To master Mastering the boundary, subregion, main vessel and nerve of neck. To understand Understanding the clinical manifestations and diagnosis of the thyroglossal cyst, branchial cyst and fistula.

Ⅳ. Ability Training Requirements Upon completion of this subject, students will be able to: 1. Pass the final exam; 2. Use head mirror, tongue depressor, anterior rhinoscope, posterior rhinoscope, indirect laryngoscope, otoscope, tune fork etc to inspect patients; 3. Manage some common diseases of otorhinolaryngology and head ＆neck. Ⅴ. Hours Distribution Teaching contents Lectures Experiments 30 16 Rhinology 6 4 Pharyngology 6 3 Laryngology 6 3 Otology 10 4 Neck 2 2

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Ⅵ. Assessment: Quizzes 10% Clinical Clerkship 10% Final Test 80% Total 100%

Ⅶ.Textbook and ReferenceS Textbook Otolaryngology. Editor by Yan Liying, Zhang Shaoqiang. Publishing by Dean’s Office Xi’an Jiaotong University, 2004. Reference book Cummings Otolaryngology Head & Neck Surgery, Fifth Edition. Publishing by Mosby, Inc. 2010.

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Critical Care Medicine

Credits: 2 Total hours: 48 Lectures hours: 32 Experiment hours: 16 Grade: 5th Semester: 2 Hai-Bo Qiu Compilers: Ling Liu Email: [email protected]

Preface This course focuses on advanced concepts of critical care related to multi-organ/system function and dysfunction. Clinical care relating to physiology, assessment, pathophysiology, system failure, and clinical management of the cardiovascular system, pulmonary system, renal system, and endocrine system are addressed. Core concepts of complex pathophysiology, current treatment modalities, and advanced intensivist roles are integrated in the discussions of providing care to critically ill patients.

Ⅰ. Preamble and Objectives 1. Summarize normal function and structure of the cardiovascular, pulmonary, renal and others. 2. Describe the major pathophysiology underlying common complex disorders of the cardiovascular, pulmonary, renal, and others. 3. Identify appropriate assessment and management for patients with complex cardiovascular, pulmonary, renal, and others. 4. Describe indications for and associated interventions for patients undergoing diagnostic procedures of the cardiovascular, pulmonary, renal, and others. 5. Summarize clinical indications and management of hemodynamic monitoring and other specialized equipment used in the care of critically ill patients. 6. Analyze data obtained through specialized assessment equipment and laboratory tests used to evaluate the cardiovascular, pulmonary, renal, and others in critically ill patients.

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7. Evaluate current evidence of practice in caring for patients with complex alterations of the cardiovascular, pulmonary, renal, and others. 8. Other supporting treatment including nutrition and fluids, electrolytes, acid-base management, etc. 9. Summarize the definition of acquired infection in hospital and reasonable application of antibiotics. 10. Describe indications for and associated cardiac pulmonary cerebral resuscitation and how to perform CPR.

Ⅱ.Contents and Requirements Chapter 1. Preface To be familiar with To be familiar with the current treatment modalities, and advanced intensivist roles of providing care to critically ill patients. To understand To understand the concepts and main purpose of critical care related to multi-organ/system function and dysfunction.

Chapter 2. Recognition and Assessment of the Seriously ш Patient To master To master how to recognize the early signs and symptoms of critical illness To be familiar with To be familiar with the initial assessment and symptoms of critical illness To understand To understand the importance of early identification of patients at risk of life threatening illness or injury and the importance of early intervention

Chapter 3. Diagnosis and Management of Acute Respiratory Failure To master To master the definition and classification of acute respiratory failure To be familiar with To be familiar with the oxygen supplementation strategies in acute respiratory failure 419

To understand To understand the pathophysiology and manifestation of acute respiratory failure Chapter 4. Airway Management To master To master the signs of threatened airway To be familiar with 1. To be familiar with the manual techniques for establishing an airway and for mask ventilation; 2. To be familiar with the proper application of airway adjuncts, and preparation for endotracheal intubation (including the recognition of a potentially difficult intubation); 3. To be familiar with the alternation methods of establishing an airway when endotracheal intubation cannot be accomplished To understand To understand the pathophysiology and manifestation of airway obstruction

Chapter 5. Mechanical Ventilation To master To master the indications for noninvasive and invasive positive-pressure ventilation To be familiar with To be familiar with the characteristics of different types of breaths and modes of mechanical ventilation; ventilator settings and monitoring needs for the initiation of mechanical ventilation; the guidelines for initial ventilator management that apply to specific clinical situations To understand To understand the interactions between ventilatory parameters and modifications needed to avoid harmful effects of mechanical ventilation

Chapter 6. Cariodpulmonary/Cerebral Resuscitation To master To master how to identify patients who are likely to benefit from cardiopulmonary resuscition; to master important treatment issues in cardiopulmonary resuscition To be familiar with To be familiar with the goals and interventions for brain protection and recovery, including use of hypothermia; To be familiar with specific cardiorespiratory events that occur in critically ill, 420

ventilated patients To understand To understand the delegating responsibility during a resuscitation process

Chapter 7. Monitoring Blood Flow, Oxygenation To master To master disorders of blood flow and oxygenation To be familiar with To be familiar with the determinants of oxygen balance To understand To understand the principles and limitations of techniques for monitoring oxygen balance

Chapter 8. Diagnosis and Management of Shock To master To master the four main categories of shock To be familiar with To be familiar with the general principles of shock management; To be familiar with the differential diagnosis of oliguria To understand To understand the goals of resuscitation in shock, and the physiologic effects of vasopressor and inotropic

Chapter 9. Monitoring Acid-Base Status To master To master the normal acid-base status and the classification of acid-base disorders To be familiar with To be familiar with the use of acid-base status as a monitor in the seriously ill patients, including evaluation of acid-base disorder To understand To understand the complex acid-base disorders

Chapter 10. Diagnosis and Management of Shock 421

To master To master the four main categories of shock To be familiar with 1. To be familiar with the general principles of shock management; 2. To be familiar with the differential diagnosis of oliguria To understand To understand the goals of resuscitation in shock, and the physiologic effects of vasopressor and intropic

Chapter 11. Basic Trauma and Burn Support To master To master how to prioritize and initiate a timely assessment of the traumatized patient To be familiar with To be familiar with treatment of life-threatening injury, and the response to changes in patient’s status To understand To understand the use of radiography to identify injury and initiate early burn management

Chapter 12. Basic Trauma and Burn Support To master To master how to prioritize and initiate a timely assessment of a traumatized patient To be familiar with To be familiar with the treatment of life-threatening injury, and the response to changes in patient’s status To understand To understand the use of radiography to identify injury and initiate early burn management

Chapter 13. Life-Threatening Infection To master To master terminology specific to life-threatening infections To be familiar with 1. To be familiar with the risk factors for the development of infection; 422

2. To be familiar with the systemic and site-specific clinical manifestations of life-threatening infections; 3. To be familiar with the antimicrobial treatment for empiric therapy and for specific infections To understand 1. To understand the use of clinical laboratory tests in the diagnosis of possible infections; 2. To understand the different clinical and epidemiologic variables used to guide the selection of antimicrobial therapy

Chapter14. Management of Life-Threatening Electorlyte and Metabolic Disturbances To master To master the management of severe hyperglycemic syndromes To be familiar with 1. To be familiar with the clinical manifestations of severe electrolyte disturbances; 2. To be familiar with emergent management of electrolyte disturbances; 3. To be familiar with acute adrenal insufficiency and appropriate treatment To understand To understand the causes of severe electrolyte disturbances

Ⅲ.Ability Training Requirements Upon completion of this subject, students will be able to know the concepts of critical care related to multi-organ/system function and dysfunction, and be familiar with the clinical management of airway, respiratory failure (include mechanical ventilation), CPR, shock, heart failure, renal failure, multiple trauma, sever infection, and life-threatening electorlyte and metabolic disturbances. Also the students will be able to understand the core concepts of complex pathophysiology, current treatment modalities, and advanced intensivist roles.

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Ⅳ. Hours Distribution

Content Lecture Discuss Lab Clinical Clerkship 32 Preface 3 Recognition and Assessment of the 3 Seriously ш Patient Diagnosis and Management of Acute 3 Respiratory Failure Airway Management 2 Mechanical Ventilation 3 Cariodpulmonary/Cerebral Resuscitation 2 Monitoring Blood Flow, Oxygenation 2 Monitoring Acid-Base Status 2 Diagnosis and Management of Shock 3 Basic Trauma and Burn Support 3 Life-Threatening Infection 3 Management of Life-Threatening 3 Electorlyte and Metabolic Disturbances

Ⅴ.Assessment

Coursework 20 % Attendance and Performance 20% Final Test 60 % Total 100%

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Ⅵ.Textbook and references Text Book Fundamental Critical Care Support (FCCS) Reference Books Textbook of Critical Care. Expert Consult Premium Edition – Enhanced Online Features and Print. By Jean-Louis Vincent, MD PhD, Edward Abraham, MD, Patrick Kochanek, MD, Frederick A. Moore, MD, FACS, FCCM and Mitchell P. Fink, MD Journals 1. Critical Care Medicine 2. Intensive Care Medicine 3. Chest Useful web sites 1. http://www.esicm.org/ 2. http://sccm.cma.org.cn/ 3. http://www.sccm.org/Pages/default.aspx

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Oncology

Credits: 2 Total hours: 48 Lectures hours: 32 Experiment hours: 16 Grade: 5th Semester: 2 Xiang-Yu Su Compiler: Email: [email protected]

Ⅰ. Course Description Cancer is not a single illness but a collection of many diseases that share common features. Cancer is widely viewed as a disease of genetic origin caused by mutations in DNA that make a cell to multiply uncontrollably. This course deals with the basic problem of cancer including the introduction of incidence, epidemiology and etiology of malignant disease, grading, staging, and spreading of tumors, terminology and classification of tumors, methods of treatment (modalities) for malignant disease, surgery, radiotherapy, chemotherapy and hormone therapy, anatomical, physiological and biological factors affecting treatment choice. On successful completion of this unit, students should be able to identify tumor formation and characteristics, describe broad tumor classifications and their modes of spread, identify methods of staging and grading a malignant tumor, describe the aetiological and epidemiological influences in relation to malignant disease and identify the factors affecting the choice of treatment modality for patients with malignant disease. Although most medical students are not going to become oncologists, a thorough knowledge of oncology is fundamental for them as further doctors. One semester course includes lectures and discussions.

Ⅱ. Contents and Requirements Introduction Objectives Knowledge At the end of the course the student will be able to:

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1. Know well the concept of carcinogenesis. 2. Know well the principle of treatment. 3. Describe the diagnostic methods of cancer. 4. Describe the classification and anatomic staging of cancer. 5. Understand the epidemiology of cancer. 6. Understand the etiology of cancer. 7. Understand the prognosis-related factors of cancer. Course Contents Theory 1. Concept of carcinogenesis 2. Epidemiology of cancer (1) Changes in incidence (2) Age and sex (3) Race and ethnicity 3. Etiology of cancer (1) Environmental and industrial chemical carcinogens (2) Medical drug-induced carcinogens (3) Radiation carcinogenesis (4) Virus and immunologic mechanisms (5) Lifestyle 4. Diagnostic methods for cancer (1) Molecular tumor markers (2) Typical clinical presentations (3) Early clinical detection (4) Screening procedures (5) Molecular pathology of cancer (6) Oncological imaging techniques（CT, MRI, B-us, PET / CT） 5. Classification and anatomic staging of cancer (1) The goals of classification (2) Histopathologic classification (3) Anatomic staging and classification (TMN classification) 6. Principles of treatment 427

(1) Surgical treatment principles (2) Radiation treatment principles (3) Medical treatment principles 7. Prognosis-related factors of cancer (1) The concept of mortality rate (2) The concept of morbidity rate

Chapter 1. ETIOLOGY OF CANCER Objectives Knowledge At the end of the course the student will be able to: 1. Be acquainted with cancer incidence and mortality. 2. Be acquainted with differences of cancer incidence and cancer prevalence. 3. Master the significance of cancer registry. 4. Know about the cancer distribution in gender and geography. 5. Master epidemiological information of common cancers. 6. Master risk factors associated with cancer and cancer prevention. 7. Know about etiological factors of several common cancers. Skills At the end of the course the student will be able to: 1. Understand the definition of cancer incidence and mortality. 2. Distinguish between cancer incidence and cancer prevalence. 3. Know the worldwide cancer prevalence and gender and geographical distribution. 4. Understand the etiology and prevention of common malignant tumors. COURSE CONTENTS Theory 1. Global problem of cancer 2. Cancer registry and statistics 3. Gender and geographic variability of cancer 4. Epidemiological information of several common cancers 5. Cancer risk factors and prevention 6. Cancer etiology by site-specific cancer 428

Chapter 2. PATHOLOGY OF NEOPLASM Objectives Knowledge At the end of the course the student will be able to: 1. Understand the concepts of definition, nomenclature and morphology of neoplasms. 2. Have knowledge of atypical neoplasms and differentiation and anaplasia of neoplasms. 3. Understand the growth and spread of neoplasms. 4. Master the rules of grading and staging of tumors. 5. Have knowledge of clinical features of neoplasms. 6. Have an understanding of etiology, epidemiology and diagnosis of tumors. 7. Know the common types of human tumors. Skills At the end of the course the student will be able to: 1. Distinguish the benign tumors with the malignant tumors by the nomenclature. 2. Differentiate the common benign and malignant tumors according to the gross appearance and microscope morphology of tumors. 3. Give the proper histological grading of the malignant tumors. 4. Use the TNM system to give the right staging of the malignant tumors. 5. Master the general methods of pathologic diagnosis for the neoplasms. 6. Have knowledge of the tumor markers. 7. Judge the histological type of tumors. Course Contents Theory 1. Definitions, nomenclature and morphology (1) Definitions ① Scientific definition ② Three important features in neoplastic hyperplasias, especially malignant tumors. A. Excessive hyperplasia B. Abnormal differentiation C. Persistent and progressive spread (2) Nomenclature ① Nomenclature of benign tumors 429

② Nomenclature of malignant tumors ③ Special nomenclature for some neoplasm’s ④ The different characteristics of both benign and malignant tumors (3) Morphology ① Gross appearance of tumors ② Histological structure of tumors A. Parenchyma B. Stroma 2. Atypia, differentiation and anaplasia of neoplasms (1) Atypia ① Architectural atypia ② Cytologic atypia A. Nuclear pleomorphism B. Cytoplasmic changes (2) Differentiation (3) Anaplasia 3. Growth and spread of neoplasms (1) Growth ① Rates of growth ② Pattern of growth A. Growth by expansion B. Growth by infiltration C. Exophytic growth (2) Spread of neoplasms ① Direct spreading ② Metastasis a) Lymphatic metastasis b) Hematogenous metastasis c) Seeding metastasis ③ Process and mechanisms of spread 4. Grading and staging of tumors (1) Grading of tumors 430

(2) Staging of tumors (the most widely applicable TNM staging system) ① T: tumor ② N: involvement of local lymph nodes ③ M: presence of distant metastases 5. Clinical features of neoplasms (1) Effects of tumor on host ① Local and hormonal effects ② Cancer cachexia ③ Paraneoplastic syndromes ④ Summary of common clinical features (2) Laboratory diagnosis of cancer ① Morphologic methods A. Cytologic smears B. Biopsy C. Immunocytochemistry D. Flow cytometry ② Biochemical assays ③ Molecular diagnosis 6. Etiology, epidemiology and diagnosis of tumors (1) Etiology of tumors (2) Epidemiology of tumors (3) Diagnostics of tumors 7. Brief introduction of common tumors (1) Epithelial tumors and related lesions ① Squamous cell tumors A. Squamous cell papilloma B. Atypical hyperplasia and carcinoma in site: mild atypical hyperplasia, moderate atypical hyperplasia, severe atypical hyperplasia C. Carcinoma in situ D. Squamous cell carcinoma ② Glandular tumors A. Adenoma: papillary adenoma, tubular adenoma, papillotubular adenoma 431

B. Adenocarcinoma: papillary adenocarcinoma, tubular adenocarcinoma, mucinous adenocarcinoma, signet-ring cell carcinoma (2) Mesenchymal tumor ① Benign mesenchymal tumors A. Lipoma B. Angiolipomas C. Leiomyoma D. Chondromas E. Granular cell tumor F. Fibroma G. Haemangiomas ② Malignant mesenchymal tumors A. Malignant fibrous histiocytoma (MFH) B. Fibrosarcoma C. Liposarcoma D. Rhabdomyosarcoma E. Leiomyosarcoma F. Synovial sarcoma G. Pleural mesothelioma H. Malignant vascular tumors

Chapter 3. HEAD AND NECK TUMORS Objectives Knowledge At the end of the course the student will be able to: 1. Know well, the general concept of thyroid cancer and its treatment principles. 2. Have an understanding of squamous cell carcinomas of the head and neck and the theory of chemotherapy. 3. Understand the concept of the nasopharynx cancer and its clinical features. 4. Understand the general concept of paranasal sinus cancer. 5. Have knowledge of tumors of the salivary glands.

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Skills At the end of the course the student will be able to: 1. Be acquainted with usual symptom of thyroid cancer and its diagnosis. 2. Master the four main treatment methods for squamous cell carcinomas. 3. Know about Radiotherapy for nasopharynx cancer. 4. Master main detection and diagnosis of paranasal sinus cancer. 5. Be acquainted with bimanual examination of salivary glands. Course Contents Theory 1. Thyroid cancer (1) Anatomy of thyroid: location of the recurrent laryngeal nerve (2) Histopathology and etiology: four types of thyroid cancer (3) Detection and diagnosis： ① The usual symptom of thyroid cancer ② Fine needle aspiration ③ X-ray and ultrasonography ④ CT, MRI, PET/CT (4) Treatment ① Theory for total thyroidectomy in Western countries ② Theory for partial thyroidectomy in Asian countries ③ Three types of neck dissection ④ Complications of surgery ⑤ Theory of thyroid hormone therapy after operation (5) Prognosis: Main prognosis factors related to thyroid cancer 2. Squamous cell carcinomas of the head and neck (1) Pathology and etiology (2) Detection and diagnosis ① Usual symptom of squamous cell carcinomas ② Method of bimanual palpation (3) Treatment ① Goals of treatment in head and neck oncology ② Four main treatment methods for squamous cell carcinomas 433

③ General principles of surgical resection ④ Advantage of radiotherapy ⑤ Role of chemotherapy and its theory (4) Prognosis 3. Tumors of the nasopharynx (1) Pathology and etiology ① Variety of histopathology ② Pathogenesis (2) Detection and diagnosis ① Usual presentations of cancer of nasopharynx ② Main organ of metastases ③ Nasopharyngoscope (3) Treatment ① Reason for radiotherapy in nasopharynx cancer ② Adjuvant chemotherapy ③ Application of surgical resection (4) Prognosis 4. Paranasal sinus cancer (1) Pathology and etiology ① Four paranasal sinuses and their location ② Variety of histopathology (2) Detection and diagnosis ① Typical presentations of paranasal sinus cancer ② CT, MRI ③ Rhinoscopy, sinoscopy, (3) Treatment ① Combined surgical treatment and radiotherapy ② Reconstruction (4) Prognosis 5. Tumors of the salivary glands (1) Anatomy ① Three major salivary glands 434

② Adjuvant structures of parotid gland and submandibular gland (2) Pathology and etiology: Variety of histopathology (3) Detection and diagnosis： ① Usual symptom of salivary gland tumors ② Malignant features of parotid tumors ③ Obstruction of the submandibular duct or inflammation of the gland ④ The method of bimaual examination ⑤ X-ray and ultrasonography (4) Treatment ① Indications for surgery nasopharynx cancer ② Role of radiotherapy in salivary gland tumors (5) Prognosis

Chapter 4. Breast Tumor Objectives Knowledge At the end of the course the student will be able to: 1. Describe the anatomy of breast. 2. Choose tests, imaging, and diagnostic studies and procedures which are helpful in confirming the diagnosis and in guiding surgical decisions. 3. Recognize associated histopathologic findings, classifications and staging. 4. Discuss outcome, prognosis, future surgical improvements, and ongoing controversies. Skills At the end of the course the student will be able to: 1. Diagnose a mass of breast by medical history, physical examination and auxiliary examination. 2. Interpret the results of imaging examination and perform appropriate management. 3. Know principles of operative surgery, including pre-operative, intra-operative and postoperative management. Course Contents Theory 1. Anatomy of breast 435

(1) General description of the breast (2) Vasculature of the breast 2. Examination of breast (1) Medical history and physical exam (2) Imaging tests for breast disease diagnosis (3) Nipple discharge examination (4) Biopsy 3. Benign breast tumors (1) Fibroadenoma (2) Phyllodes tumors (3) Intraductal papilloma (4) Granular cell tumor (5) Fat necrosis 4. Breast cancer (1) Etiology (2) Genetic factors (3) Pathophysiology (4) Clinical (5) Staging (6) Histological Findings (7) Medical therapy ① Treatment of in situ disease ② Treatment of invasive disease ③ Surgical therapy ④ Adjuvant hormonal therapy ⑤ Adjuvant chemotherapy ⑥ Radiotherapy 5. Outcome and prognosis Chapter 5. CHEST TUMORS Objectives Knowledge At the end of the course the student will be able to: 436

1. Know well the general concepts of non small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). 2. Have an understanding of esophageal cancer and the principle of surgical treatment. 3. Have knowledge in the concept of the mediastinal tumors. 4. Have knowledge in the clinical characteristics of thymoma. 5. Have knowledge in the radiochemotherapy for small cell lung cancer. Skills At the end of the course the student will be able to: 1. Master usual symptom of lung cancer and its diagnosis 2. Be acquainted with main treatment methods for non small cell lung cancer 3. Know about theory of radio-chemotherapy for SCL 4. Understand diagnosis and main treatment of esophageal cancer 5. Understand classifications of mediastinal tumors. Course Contents Theory 1. Lung cancer (1) Practical anatomy of lung. ① Structures of pulmonary hilum. ② Brochopulmonary segments (2) Histology: two types of lung cancer (3) Diagnosis and staging. ① Clinical manifestations of lung cancer ② Noninvasive modalities for lung cancer ③ Invasive modalities for lung cancer ④ Staging of NSCLC (4) Treatment ① Principles and main method of surgical treatment for NSCLC ② Lymphatic dissection ③ The complications of surgery. ④ Adjuvant chemoradiotherapy for NSCLC ⑤ Principles for the treatment of SCLC (5) Prognosis: main prognosis factors related to NSCLC and SCLC. 437

2. Esophageal cancer (EC) (1) Histopathology and etiology (2) Clinical manifestations and diagnosis ① Usual symptom of EC ② Method of diagnosis (3) Treatment ① Different surgical choice between Western and Asian surgeons ② General principles of surgical resection ③ Reconstruction of digestive tract ④ Advantage of radiotherapy ⑤ Role of chemotherapy and its theory in the treatment of EC (4) Prognosis 3. Tumors of mediastinum (1) Mediastinal anatomy ① Compartment model of mediastinum ② Common tumors at different compartment (2) Clinical manifestations and diagnosis ① Usual presentations of mediastinal tumors ② Non-incursions methods for diagnosis ③ Surgical approaches to biopsy. (3) Treatment ① Treatment of thymoma ② Management of myasthenia gravis (4) Prognosis

Chapter 6. HEPATOBILIARY TUMORS Objectives Knowledge At the end of the course the student will be able to: 1. Know about main steps of the development of hepatobiliary surgery. 2. Understand liver anatomy. 3. Know about benign liver tumors. 438

4. Primary liver cancer (HCC) (1)Understand the risk factors. (2)Know about surveillance and prevention. (3)Master diagnosis: ① Imaging examination ② Laboratory tests ③ Staging systems (4)Be acquainted with treatment: ① Curative treatments ② Palliative treatments 5. Be acquainted with metastasis liver cancer 6. Know about cholangiocarcinoma. Skills At the end of the course the student will be able to: 1. Understand liver anatomy: the eight segments division and blood supply of the liver. 2. Benign liver tumors (1) Know about the most common benign tumors of liver. (2) Know about differential diagnosis of human heamangioma and HCC. 3. Primary liver cancer (HCC) (1) Understand risk factors. (2) Know about mass screening. (3) Masterdiagnosis: imaging examinations and laboratory tests (4) Master treatment: curative hepatectomy, liver transplantation, RFA, TACE, PEI, medication (5) Understand prognostic factors 4. Be acquainted with metastasis liver cancer: the common metastasis cancer of liver. 5. Know about cholangiocarcinoma: classification and diagnosis. Course Contents Theory 1. Main steps of the development of hepatobiliary surgery 2. Liver anatomy (1) The eight segments division of liver anatomy 439

(2) Blood supply of the liver: portal vein, arteriae hepatica 3. Benign liver tumors (1) The most common benign tumors of liver (2) Hepatic heamangioma ① Clinical symptom and sign ② Imaging examination ③ Treatment principles (3) Liver cell adenomas 4. Primary liver cancer (HCC) ① Risk factors ② Epidemiology and prevention ③ Diagnosis ① Imaging examination ② Laboratory tests ③ Staging (5)Treatment ① Curative treatments ② Palliative treatments 5. Metastasis liver cancer (1) The most common metastasis cancer of liver (2) Metastatic colorectal cancer (3) Metastatic breast cancer (4) Metastatic pancreas cancer (5) Metastatic Melanoma 6. Cholangiocarcinoma (1) Clinical symptom and sign (2) Diagnosis ① Radiological studies ② Laboratory tests (3) Classification (4) Treatment options

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Chapter 7. GASTRIC CANCER Objectives Knowledge At the end of the course the student will be able to: 1. Describe epidemiology and etiology of gastric cancer. 2. Describe prevention and early detection in gastric cancer. 3. Define pathology of gastric cancer, both histological and gross type. 4. Enumerate clinical features of gastric cancer. 5. Describe diagnostic principles of gastric cancer. 6. Define staging and assessment of gastric cancer: Dukes’s and TNM System. 7. Describe treatment of gastric cancer. (1)Primary therapy: radical operation and palliative operation. (2)Adjuvant therapy: chemotherapy and irradiation. (3)Biological therapy (immunotherapy). 8. Define the prognostic factors of colorectal cancer. Skills At the end of the course the student will be able to: 1. Diagnose gastric cancer. 2. Plan various laboratory tests for patients and interpret the results. 3. Provide primary treatment for a patient of gastric cancer. 4. Acquire principles of operative surgery, including pre-operative, operative and post operative care and monitoring. Course Contents Theory 1. Epidemiology and etiology 2. Prevention and early detection 3. Pathology 4. Clinical presentation 5. Diagnosis 6. Staging and assessment 7. Treatment 8. Prognosis 441

Chapter 8. COLORECTAL CANCER Objectives Knowledge At the end of the course the student will be able to: 1. Describe epidemiology and etiology of colorectal cancer. 2. Describe screening and prevention in colorectal cancer. 3. Define the histopathology classification of colorectal cancer. 4. Define the diagnosis and staging of colorectal cancer: enumerate clinical features of colon cancer and rectal cancer. 5. Describe the treatment of colorectal cancer. (1)Surgical therapy: colon cancer, rectal cancer, emergency surgery, liver resection (2)Adjuvant therapy: chemotherapy, irradiation and biological therapy 6. Enumerate the content of surveillance. Skills At the end of the course the student will be able to: 1. Diagnose colorectal cancer. 2. Plan various tests for patients and interpret the results. 3. Provide primary treatment for a patient of colorectal cancer. 4. Acquire principles of operative surgery, including pre-operative, operative and post operative care and monitoring. Course Contents Theory 1. Epidemiology and etiology 2. Screening and prevention 3. Pathology 4. Diagnosis and staging 5. Treatment 6. Surveillance

Chapter 9. GYNECOLOGICAL CANCER Objectives Knowledge 442

At the end of the course the student will be able to: 1. Master basal knowledge about the most common gynecological cancer. (1)Cervical carcinoma (2)Endometrial carcinoma (3)Ovarian cancer 2. Master basal skill about gynecological cancer. (1) Take a medical history. (2) Master gynecologic examination. (3) Grasp the special diagnostic methods about various gynecological cancers. Course Contents Theory 1. Cervical carcinoma (1) Brief introduction (2) Epidemiology ① Incidence and prevalence ② Risk factors (3) Symptoms and signs ① Symptoms and signs of cervical cancer ② Three types of primary tumors (4) Diagnosis ① Pap smear ② Pelvic examination ③ Imaging examinations ④ Other diagnostic tests (5) Staging (6) Main histopathological types (7) Main treatment methods ① Surgical treatment ② Radiation ③ Chemotherapy (8) Prognosis (9) Prevention 443

2. Endometrial carcinoma (1) Epidemiology ① Incidence and prevalence ② Risk factors (2) Symptoms and signs (3) Diagnosis (4) Classification ① Staging of cancer ② Grading of cancer ③ Histopathological types of cancer (5) Treatment (6) Prognosis (7) Follow-up (8) Treatment of recurrent cancer 3. Ovarian cancer (1) Brief introduction (2) Epidemiology ① Incidence and prevalence ② Risk factors (3) The major classification of ovarian cancer ① Epithelial tumors ② Germ cell tumors ③ Sex cord-stromal cell tumors (4) Symptoms and signs (5) Diagnosis ① Ask a medical history ② Perform pelvic examination ③ Interpret imaging examinations ④ Take other diagnostic tests (6) Staging of cancer (7) Grading of cancer (8) Main treatment methods 444

① Surgical treatment ② Chemotherapy ③ Radiation ④ Other forms of therapy (9) Follow-up

Chapter 10. ONCOLOGICAL IMAGING Objectives Knowledge At the end of the course the student will be able to: 1. Master the imaging features of 3 types of primary lung carcinoma (central，peripheral and diffuse type). 2. Be acquainted with the imaging features appearances of mediastinal tumors (thymoma and neurogenic neoplasm). 3. Master the imaging features of HCC. 4. Master the imaging features of breast carcinoma on mammogram and MRI. Skills At the end of the course the student will be able to: 1. Be acquainted with clinical application of X-ray, CT and MRI. 2. Master the imaging features of pulmonary metastases. 3. Master the imaging features of hepatic hemangioma. 4. Master the features of breast fibroadenoma on mammogram and MRI. Course Contents Theory 1. General principles (1) History (2) Clinical application of radiography (3) CT Examination methods & clinical applications (4) Advantages and disadvantages of MRI 2. Chest (1) Technical considerations (2) Normal X-ray anatomy 445

① Chest wall ② Mediastinum ③ Trachea and bronchi ④ Lung lobes and lung field (3) Normal CT anatomy (4) Pulmonary tumor ① Primary bronchogenic carcinoma A WHO classification B Imaging classification: Central type; Peripheral type; Diffuse type; Spread of lung cancer ② Other malignant primarily tumors ③Pulmonary metastases ④Benign tumors- hamartoma (5) Mediastinal tumor ① Thymoma ② Teratoma ③ Lymphoma ④ Neurogenic neoplasm 3. Liver and Pancreas (1) Normal anatomy of liver (2) Common diseases of the liver ① Hepatic cyst ② Hepatic abscess ③ Cavernous haemangioma ④ Fatty liver ⑤ Hepatic cirrhosis ⑥ Hepatocellular carcinoma (HCC) ⑦ Cholangiocarcinoma ⑧ Hepatic metastasis (3) Normal anatomy of pancreas (4) Common diseases of pancreas ① Pancreatitis 446

② Neoplasm A. Ductal adenocarcinoma of pancreas B. Islet cell tumors of the pancreas 4. Breast (1) The X-ray anatomy of normal breast (2) Common diseases of the breast ① Mastitis and breast abscess ② Fibroadenomas ③ Breast cancer

Chapter 11. RADIOTHERAPY Objectives Knowledge At the end of the course the student will be able to: 1. Know about the introduction of radiotherapy. (1) Know about brief History of radiotherapy. (2) Know about the basic concepts of radiotherapy. 2. Understand clinical radiobiology. (1) Understand basic concepts of radiobiology. (2) Be acquainted with basic principle of the rays action. (3) Know about fractionation of evaluating radiobiology. 3. Know about radiation physics. (1) Understand basic concepts of radiation physics. (2) Know about equipment of radiation therapy. (3) Be acquainted with simple course of radiation therapy. (4) Be acquainted with technique of radiation therapy. Skills At the end of the course the student will be able to: 1. Understand clinical Radiobiology. (1) Master goal of radiotherapy. (2) Understand the concept of radiobiology. (3) Know about the target of radiotherapy. 447

(4) Know about the direct effect and indirect effect. (5) Know about the cause of oxygen effect. (6) Know about early-responding tissues and late-responding tissues. (7) Know about fractionation of radiotherapy: repair of sub-lethal, reoxygenation, redistribution, and repopulation. 2. Know about radiation physics. (1) Know about concepts of dose. (2) Know about brachytherapy and teletherapy equipment. (3) Understand the dose characteristics of high energy X-rays and electronics rays. (4) Be acquainted with the simple course of radiation therapy. (5) Know about conformal radiotherapy, intensity modulated radiotherapy(IMRT), stereotactic radiotherapy. Course Contents Theory 1. Principles of radiotherapy (1) The goal of radiotherapy (2) Basic Concepts of Radiotherapy 2. Clinical Radiobiology (1) The concept of Radiobiology (2) The target of Radiotherapy (3) Direct effect and indirect effect (4) The cause of oxygen effect (5) Early-responding tissues and late-responding tissues (6) Fractionation of radiotherapy: repair of sub-lethal, reoxygenation, redistribution, and repopulation (7) The criteria in research for evaluate the effect of radiotherapy 3. Radiation physics (1) Basic Concepts of Radiation physics: Dose. (2) The equipment for and basic technique of Radiation therapy. (3) The simple course of Radiation therapy. (4)The advanced technique of Radiation therapy ： Conformal radiotherapy, intensity modulated radiotherapy (IMRT), stereotactic radiotherapy. 448

Chapter 12. RADIATION ONCOLOGY Objectives Knowledge At the end of the course the student will be able to: 1. Lung cancer (1) Be acquainted with the principle of multi-disciplinary treatment for lung cancer. (2) Master the curative radiotherapy for non-small cell lung cancer. (3) Understand the post-operative radiotherapy for non-small cell lung cancer. (4) Understand the chemo-radiotherapy for non-small cell lung cancer. (5) Master the treatment principle for small cell lung cancer. (6) Master radiotherapy for small cell lung cancer. (7) Be acquainted with radiotherapy for superior vena cava syndrome. (8) Know about progress of radiation oncology for lung cancer (fraction, conformal therapy, IMRT). 2. Esophageal carcinoma (1) Master the principle of radiotherapy for esophageal carcinoma. (2) Master radical radiotherapy for esophageal carcinoma. (3) Understand post-operative radiotherapy for esophageal carcinoma. (4) Know about new adjuvant radiotherapy for esophageal carcinoma. (5) Be acquainted with concomitant chemo-radiotherapy for esophageal carcinoma. 3. Breast cancer (1) Master the principal of multi-disciplinary treatment for early stage breast cancer. (2) Understand tangential field radiotherapy after breast conservation operation. (3) Know about the progress of radiotherapy for early stage breast cancer. (4) Master the principal of radiotherapy for patients received radical resection. (5) Understand post-operative radiotherapy for patients receive radical resection. (6) Master radiotherapy for recurrence disease. 4. Cervical carcinoma (1) Master the clinical staging and treatment principle. (2) Master pelvic teletherapy. (3) Understand brachytherapy for cervical carcinoma. 5. Radiotherapy for metastasis disease 449

(1) Master brain metastasis. (2) Master bone metastasis. (3) Master lung metastasis. Skills At the end of the course the student will be able to: 1. Master the diagnosis and differential diagnosis. 2. Master the indications and contra-indications of radiotherapy for each cancer. 3. Know about the technology of radiotherapy. 4. Know about dose and field. 5. Understand the complications and treatment. Course Contents Theory 1. Relative basic knowledge 2. Staging and treatment principle of radiotherapy 3. Technology of radiotherapy 4. Complications and management 5. Progress of radiation oncology Practicals 1. Image diagnosis 2. Physical examination 3. Simulation 4. Contour for target volume and treatment planning system 5. Linear accelerator

Chapter 13. CHEMOTHERAPY Objectives Knowledge At the end of the course the student will be able to: 1. Understand the principles of chemotherapy. (1)Know about brief history. (2)Understand characteristics of cancer. (3)Master the basic concepts of chemotherapy. 450

(4)Understand tumor response to chemotherapy. 2. Know well clinical trials. (1)Master importance of clinical trials to the practice of medicine. (2)Know well how clinical trials differ from other designs of observational study. (3)Be acquainted with the advantages and limitations of the design. Skills In the end of the course the student will be able to: 1. Master the principles of chemotherapy. (1) Understand the purpose of chemotherapy. (2) Know about the classification of response. (3) Master the types of chemotherapy. 2. Master clinical trials. (1) Be acquainted with Different types of clinical trials. (2) Master phases of clinical trial. (3) Master design of clinical trials. Course Contents Theory 1. Goals of chemotherapy (1) For cure of cancer (2) For control of cancer (3) For palliation of symptoms of cancer 2. Type of chemotherapy (1) Cure / Control: ① Single chemotherapy ② Adjuvant chemotherapy ③ Neo- adjuvant chemotherapy ④ Concurrent chemotherapy (2) Palliative chemotherapy 3. Classification of response (1)Complete response (2)Partial response (3)Stable disease 451

(4)Disease progression 4. Trials for FDA Approval of New Therapies (1)Phase I: Safety of therapy is tested in a few normal volunteers (uncontrolled, nonblinded) (2)Phase II: Small controlled trial to test tolerability and dose effects on short term outcomes in affected individuals (3)Phase III: Large controlled trial to test the effect of the therapy on clinical outcomes (4)Phase IV: Post-approval surveillance studies to discover serious side effects in large simple & evaluate additional therapeutic uses Practice 1. Randomized clinical trial design 2. Evaluation for tumor response

Chapter 14. INTEGRATIVE ONCOLOGY Objectives Knowledge At the end of the course the student will be able to: 1. Understand general concept of integrative oncology. 2. Understand why we need integrative oncology. 3. Understand the basic principles of integrative oncology. 4. Comprehend the difference and relationship between traditional therapy (surgery, chemotherapy, radiotherapy and biotherapy) and integrative therapy. Skills At the end of the course the student will be able to: 1. Understand when patients need integrative therapy. 2. Comprehend how to integrate alternative medicine into western medicine in oncology. Course Contents Theory 1. The concept of integrative oncology 2. The history and the future of integrative oncology 3. The standard of patients receiving integrative oncology 4. The main mechanism of action of integrative therapy Practice 452

1. Diet / Nutrition / Nutritional supplements 2. Mind-body therapies (including Qigong and Psychotherapy)

Chapter 15. BIOLOGICAL THERAPY FOR CANCER Objectives Knowledge At the end of the course the student will be able to: 1. Know well, the general principles of biological therapy. 2. Have an understanding of new approaches of biological therapy. 3. Understand the concept of clinical application of biological therapy. 4. Understand the new advances in biological therapy of cancer. Skills At the end of the course the student will be able to: 1. Understand the practice of cytokine therapy. 2. Understand the practice of cell therapy. 3. Understand the practice of antibody therapy. 4. Understand the practice of cancer vaccines. 5. Understand the practice of gene therapy. Course Contents Theory 1. Cytokine therapy (1) Interleukins (2) Interferon (3) Colony-Stimulating factors (4) Tumor necrosis factor 2. Cell transfer therapy (1) Basic principles (2) Clinical applications (3) Melanoma (4) Renal cell carcinoma 3. Monoclonal antibody therapy (1) Basic principles 453

(2) Clinical applications (3) B-cell lymphomas (4) Breast cancer 4. Cancer vaccines (1) Cancer antigens (2) Basic principles (3) Clinical applications (4) DC vaccines 5. Gene therapy (1) Basic principles (2) Clinical applications (3) Suicide gene therapy Practice 1. Collect peripheral blood stem cell by using CS3000 system. 2. Do the cell culture and tissue culture. 3. Observing the infusion of the cells.

Ⅲ. Teaching Methods Multimedia teaching & interactive discussions will be used to enhance the learning process in the class.

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Ⅳ. Hours Distribution No. Contents Theory 1 Introduction 3 2 Etiology of Cancer 3 3 Pathology of Neoplasm 3 4 Pathology of Neoplasm 3 5 Head and Neck Tumors 3 6 Breast Tumor 3 7 Chest Tumors 3 8 Hepatobiliary Tumors 3 9 Gastric Cancer 3 10 Colorectal Cancer 3 11 Gynecological Cancer 3 12 Oncological Imaging 3 13 Radiotherapy 3 14 Radiation Oncology 3 15 Chemotherapy（I） 3 16 Chemotherapy（II） 3 17 Integrative Oncology 3 18 Biological Therapy for Cancer 3 Total 54

Ⅴ. Assessment: Examinations are subjective in nature containing terms explanation, choice answer and answering questions. Numerical grades will be based on the combination of quizzes, class participation and a final exam using the following guidelines: 1. Quizzes: 20% of final grade 2. Class Participation: 10% of final grade 3. Final Exam: 70% of final grade

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Ⅵ. Textbooks and reference Textbook Lee Goldman, Andrew I. Schafer. Cecil Medicine. Peking University Medical Press. 2012, 24th edition Reference 1. Robbin. Pathologic Basis of Diseases 2. Harsh Mohan. Text-Book of Pathology 3. Rosai & Ackerman. Surgery Pathology 4. Walter and Israel’s General Pathology 5. Hans-Olov, David Hunter, Dimitrios Trichopoulos, Textbook of Cancer Epidemiology 6. T. W. Shields, Thoracic Oncology 7. F.W. Sellke, Surgery of the Chest 8. L. H. Blumgart ＆ Y. Fong. Surgery of the Liver and Biliary Tract 9. Clinical Oncology, 3rd Edition 10. ACS Surgery Principles And Practice – ACS (American College of Surgeons) 11. The M.D. Anderson, Surgical Oncology Handbook, 3rd Edition 12. Sabiston, Textbook of Surgery, 17th Edition 13. Disaia Creasman, Clinical Gyneclogical Oncology 14. Steven Rosenberg, Cell Transfer Therapy 15. Steven Rosenberg, Principles and Practice of Biologic Therapy of Cancer 16. Carlos A. Perez, Luther W. Brady, Principles and Practice of Radiation Oncology, 3rd Edition 17. Cancer Principles & Practice of Oncology, 6th Edition 18. NCCN Guideline, Version 2006

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