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Training Objective: The Division of Allergy, Asthma and
Rheumatology of Chang Gung Children's Hospital in
co-operation with the pediatrician of the hospital and
faculty as well as research workers of the Chang Gung
University have developed training programs for 4th and
5th year residents in the knowledge of allergy,
immunology and rheumatology for clinical teaching and
research purposes. It is envisaged that the trained
fellows will possess the ability for independent
clinical diagnosis, therapy, teaching and research.
I.
Clinical Training:
There are over 40,000 outpatient visits per year in the
Division of Allergy, Asthma and Rheumatology for
learning demonstration. The Taipei Clinic Center and the
Children's Hospital provide well-equipped facilities for
allergy, immunology and rheumatology, including complete
lung function tests, specific and non-specific bronchial
challenge tests, exercise lung function test, nasal
resistance and flow tests, CAP allergy immunoassay
system, MAST allergy system, smearing device for nasal
mucus and sputum, exhaled nitric oxide concentration
measurements, nailfold capillaryscope and lots of basic
rheumatologic techniques including Schimer and tear
production tests, autoantibodies assay, synovial fluid
analysis, intraarticular drug injection to enable
learning of skills and knowledge.
A.
Examination, diagnosis and therapy for allergic
diseases:
1.Upper airway diseases: The fellows will learn the
techniques and diagnostic knowledge of rhinitis,
sinusitis, otitis media, tonsillitis, etc. Skin allergic
tests, immunotherapy, smearing of nasal discharge and
sputum, physical examination, x-ray interpretation,
tympanogram and how to prevent the development of
allergic disorders also will be trained.
2.Diagnosis and therapy for allergic conjunctivitis, viral
and bacterial conjunctivitis.
3. Skin diseases: The fellows will study the skills for
diagnosis of symptoms for Urticaria, Angioedema, Atopic
dermatitis, Contact dermatitis, Drug allergy, Erythema
multiforme, Erythema nodosum and other immune
mediated skin diseases with testing of skin allergy
source, adhesive tape and drug allergy tests.
4. Lower respiratory tract diseases: The fellows are
required to understand thoroughly diseases such as
asthma, allergic pneumonitis, bronchiolitis, Immotile
cilia syndrome, bronchiectasis, bronchiolitis obliterans,
vascular ring-induced asthma as well as skills for
diagnosis of pulmonary function, exercise test,
bronchial challenge test, sputum analysis,
bronchoalveolar lavage and x-ray interpretation.
5.Food allergy: including food challenge test.
6.
Diagnosis and therapy of anaphylaxis.
7.
Exhaled nitric oxide concentration measurements and its
correlation with asthma and pneumonia as well as its
role as a biomarker for airway inflammation.
B.
Rheumatology: To learn the fundamental knowledge for all
kinds of arthritis (including inflammatory, [juvenile
chronic idiopathic arthritis (JIA) or juvenile
rheumatoid arthritis (JRA), spondyloarthropathy,
psoriatic arthritis], reactive arthritis, systemic lupus
erythematosus (SLE), juvenile dermatomyositis,
vasculitis, mixed connective tissue disorder, hence, the
fellows will have the ability of diagnosis and therapy
to pick up the skills of microscopic capillary change,
Schimer test, saliva production test, intra-articular
drug injection, histologic interpretation of kidney or
skin biopsy and image studies for muscle , skeletal and
joint , as well as the evaluation of various
auto-antibodies such as ANA, Anti-DNA, Anti-histone,
Anti-cardiolipin, anti-ENA, ASLO, Anti-idiotype, p- and
c-ANCA, AECA, Anti-parietal, and Anti-thyroglobulin,
cryoblobulin etc.
C.
Diagnosis and therapy for Immunodeficiency (ID): The
fellows will study the following:
1.Primary ID including severe combined ID (SCID), DiGeorge
syndrome, adenosine deaminase deficiency(def),
nucleotide phosphorylase def., ataxia telangiectasia,
Wiskott-Aldrich syndrome, congenital X-linked
agammaglobulinemia, Selective IgA def., IgG subclass
def., Hyper-IgE syndrome and common variable ID, CGD,
etc., and also the techniques for evaluating the size of
thymus, lymphocyte proliferation response for mitogen
and antigen , anergy panel test, NBT tests,
Chemiluminescence, Surface glycoprotein test, neutrophil
phagocytosis and bactericidal assay.
2. Secondary ID: To study the influence in patients after
HIV infection, splenectomy, virus infections, and bone
marrow transplantation, therapy of immuno-suppression
agents, irradiation and its effect on immune system.
II. Research in Basic Science: Under the clinical
superiority of Chang Gung Children’s Hospital, the
Division has developed lots of projects for research
activities in the fields of immunology and molecular
biology, and has also undertaken multi-disciplinary
approach with other divisions to provide better training
of fellows in basic medical science. It is expected that
in the future, fellows will join the research team to
contribute their efforts to promote the advancement of
Chang Gung University and Chang Gung Children's
Hospital. The programs include the following:
A. Immune mechanism: the field relates to
1) preparation,
characteristics and structures of anti-bodies;
2)
functions, adjustment, and structures of MHC;
3) Immunogenetics;
4) immuno-globulins;
5)structures, and
functions of T-cell receptor; and
6) structures and
functions of complement.
B.
The growth and development of immune systems.
C.
Immunomodulation with reference to
1) molecular biology,
preparation, functions and adjustment of cytokines;
2)
inflammatory mediators, such as leukotrienes,
prostaglandin, platelet-activating factor for their
origins and functions.
D.
Immune reactions, with reference to the conversion and
reaction of IgE in causing sickness; conversion
reactions of IgG, IgA or IgM; conversion reactions of
immune complexes; and mechanism by complements and the
role of natural killers.
E.
Laboratory research work: each fellow is required to
work on at least one lab program for the understanding
of the fundamentals of immunology and the comprehension
of clinical activities. The research items may be
selected from the following list: Immuno-globulins (IgA,
IgE, IgG and subclasses) measurements, classification
and subsets of T-cells testings, B-cells, natural killer
cells, cytokines measurements, testing for supplementary
bodies using the following methods:
1) ELISA, RIA, RID,
immunoblots, high performance liquid chromatography (HPLC),
protein analysis;
2) flow cytometry, chemotaxis,
phagocytosis, cytolysis, lymphocyte proliferation, Ig
production;
3) immunofluorescence;
4) Northern,
Southern, Western blotting,
5)polymerase chain
reactions;
6) hybridomas and monoclonal antibodies
production.
7) animal models for asthma and other
allergic diseases.
III.Clinical Guidelines: All fellows must participate in
ward round, journal meetings, research seminars, case
conference, and clinic activities.
Ward round: daily ward round with attending physicians.
Journal meeting: held with adult Allergy/Rheumatology
department twice every month. Fellows will take turn
presenting recent scientific findings related to
allergy, immunology, and rheumatology.
Research seminar: in cooperation with faculty from the
Research Institute of Chang Gung University, the
attending physicians and fellows will present their
recent progress in research as well as obstacles
encountered.Case conference: held every 2 months. Fellow
1 will present special case along with other cases from
medical centers and hospital in the Great Taipei area.
IV.
Education activity:Fellows are responsible to cover junior resident, interns and medical
students to take care of in-patient in our division.
Daily teaching round will be held to discuss diagnostic
techniques, treatment strategies, and other clinical and
basic knowledge.
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