Chuang Gung Medical Foundation, Division of Pediatric Allergy, Asthma and Rheumatology - UNREGISTERED VERSION

Fellowship Training Programs
Division of Allergy, Asthma and Rheumatology Chang Gung Children's Hospital

Mar. 28, 2013
Chih-Te Wu, M.D, PhD/ Kuo-Wei Yeh, M.D.

Clinical Training:

      There are over 50,000 outpatient visits per year in the Division of Allergy, Asthma and Rheumatology for learning demonstration. The Pediatric Allergy and Asthma 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 challenge 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 wheeze as well as skills for diagnosis of pulmonary function, exercise challenge  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, oral allergy syndrome.
    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), spondyloarthropathy, psoriatic arthritis], reactive arthritis, systemic lupus erythematosus (SLE), juvenile dermatomyositis, vasculitis syndrome, 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, and newly-classified signal transduction deficiency, etc., and also the techniques for evaluating the size of thymus, lymphocyte proliferation response for mitogen and antigen , chemotaxis, NBT tests, Chemiluminescence, Surface glycoprotein test, neutrophil phagocytosis and bactericidal assay. Besides the examination technique, fellows should also learn the interpretation and genetic counseling.
     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.

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.

　

Clinical Activity:

• 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.
  

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.
  

• Fellows should also be a presenting speaker in community or school setting to teach all asthma care knowledge to the public.