A global partnership in medical education between Duke University and the National University of Singapore.

Duke University and the National University of Singapore (NUS) have partnered to launch a new medical school that brings the American style of postbaccalaureate medical education to Asia. The new institution, called the Duke-NUS Graduate Medical School (GMS) and located in Singapore adjacent to the Singapore General Hospital, admitted its inaugural class of students representing citizens of seven nations in August 2007. The project represents an investment of more than $350 million from three ministries of the Singapore government, and a commitment on Duke's part to provide senior leadership and recruit faculty from Duke, from other international locales, and from within Singapore itself. Graduating students who complete the four-year Duke curriculum will receive an MD degree awarded jointly by Duke and NUS, thereby distinguishing this school from medical education in most Asian institutions that award an MBBS degree after a five-year period of study that follows directly from secondary school. The emphasis of the Duke-NUS GMS is to prepare physician-scientists for academic careers, with plans for 20% of each class to complete a combined MD/PhD degree. This article describes events leading up to this partnership and details of the relationship, including curriculum, organizational structure, milestones, and goals.     

Effects of certain cerebral circulation activating drugs on regional cerebral blood flow in rats.

The effects of certain cerebral circulation activating drugs on regional cerebral blood flow (rCBF) in the frontal cortex (FCOR), hippocampus (HPC) and nucleus caudatus (CAD) were investigated using the hydrogen clearance method in rats. All the drugs used in the present study, i.e., ozagrel, ifenprodil, pentoxifylline, cinnarizine and dilazep, caused an increase in rCBF in the FCOR, HPC and CAD. Ozagrel was the most potent in increasing rCBF at the FCOR. Ozagrel, ifenprodil, cinnarizine and dilazep were more effective than pentoxifylline in increasing rCBF at the HPC. On the other hand, all the drugs showed almost the same potency in increasing rCBF at the CAD. These results suggested that measurement of rCBF is useful for estimating the efficacy of cerebral circulation activating drugs.     

Evaluation of hypertensive intracerebral hematomas based on the study of long-term outcome--part IV: Prognostic importance of the age of the patient and the laterality of the lesion in putaminal hematoma

The age of the patient and the laterality of the lesion are said to play an important role in determining surgical indications and prognosis of any neurosurgical disease. These two factors have been evaluated in 355 cases of putaminal haematoma, which were seen during the last 10 years after the introduction of the CT scan. Patients have been divided in three age groups; less than 59 years, 60-69 years and greater than 70 years, consisting of 235, 80 and 40 cases in each group respectively. Long-term outcome of three groups has been compared in both surgically and conservatively treated patients. The hematoma was situated on left side in 182 and on right side in 173 cases. 56.6% of left sided and 48.7% of right sided hematoma cases were operated. The long-term outcome of the two sides has also been compared in both surgically and conservatively treated patients. One has to be careful while considering patients of greater than 70 years of age as there is always some natural selection among these patients before they are referred to the hospital or are operated upon thereafter. One tends to be less aggressive for so old patients. Only in moderate type and operated cases the younger patients (less than 59 years) showed a better long-term outcome (ADL) than other surgically treated patients. Otherwise age did not effect the long-term outcome (ADL) in any type of putaminal haematoma. No effect of laterality was found in mild and very severe types of hematoma for the long-term outcome.(ABSTRACT TRUNCATED AT 250 WORDS)     

The treatment of pulmonary aspergilloma with itraconazole]

We evaluated the efficacy of Itraconazole (ITZ), a newly developed triazole antifungal agent, in 5 cases of pulmonary aspergilloma. A daily dose of 100-200 mg of ITZ was given orally for 5 to 20 months. In one patient, administration of ITZ was discontinued because of mild and transient hepatic injury. On computerized tomography and conventional roentgenogram of the chest, improvement was clearly observed in 2 of the remaining 4 cases. Symptomatic improvement, mainly disappearance of airway bleeding, was seen in 2 cases. Thus the overall improvement rate was 50% (two out of 4). No adverse response other than the hepatic injury mentioned above occurred. In one patient, who had two fungus balls previously, one of the fungus balls disappeared completely and the other decreased significantly in size during the course of treatment. In this case, the daily dose of ITZ was larger (200 mg once a day) and the plasma concentration of ITZ was extremely higher (2068 ng/ml) than in other cases (137-330 ng/ml). We conclude that ITZ is an efficacious drug in the treatment of pulmonary aspergilloma, and that this drug may be even more efficacious if we keep higher plasma concentration of ITZ.     

Effects of L-tryptophan on the development of tolerance to the antitussive effects of dihydrocodeine.

The effects of L-tryptophan on the development of tolerance to the antitussive effects of dihydrocodeine were examined in rats. Chronic co-administration of L-tryptophan with dihydrocodeine prevented the development of tolerance to the antitussive effects of dihydrocodeine. Furthermore, the antitussive effects of dihydrocodeine in dihydrocodeine-tolerant rats were fully restored by acute co-administration of L-tryptophan, as evidenced by a decrease of about 50% in the ED50 value of dihydrocodeine. Thus, it is concluded that L-tryptophan may antagonized the development of tolerance to the antitussive effects of dihydrocodeine.     

New biological properties of pyrroloquinoline quinone and its related compounds: inhibition of chemiluminescence, lipid peroxidation and rat paw edema

Pyrroloquinoline quinone (PQQ) inhibited the chemiluminescence (CL) from mouse peritoneal cells initiated by zymosan, carrageenin and N-formyl-methionyl-leucyl-phenylalanine and CL generated by the xanthine-xanthine oxidase reaction and the lipid peroxidation in the rat brain homogenate. The inhibitory activity of PQQ was more potent than that of idebenone, alpha-tocopherol and ascorbic acid in all the three assay systems. In the xanthine-xanthine oxidase reaction, PQQ had no effect on the formation of uric acid at the concentration of CL inhibition. These results suggest that PQQ might have a radical scavenger-like activity. Structure-activity relationship of PQQ and its six related compounds showed that the 7- and 9-carboxyl groups of PQQ as well as the orthoquinone structure are responsible for the radical scavenger-like activity. In addition, the -NH group in the pyrrole ring of PQQ seemed to be essential for the antilipid peroxidative activity in the rat brain homogenate. When administered i.p., PQQ inhibited the development of 0.1% carrageenin-induced paw edema in rats. These results suggest that PQQ might have therapeutic effects on various diseases, of which development or exacerbation has been known to be associated with radical oxygens.