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Objective:To explore the application of Bloom target teaching theory combined with PBL teaching mode in standardized residency training of respiratory.Methods:A total of 44 residents of Batch 2019 who had been in respiratory department of our hospital for 2 months on rotation were selected as the control group, and traditional teaching training was adopted in the group. In addition, 41 residents of Batch 2020 who were enrolled in the respiratory department of our hospital for a 2-month residency training rotation were selected as the research group, and Bloom target teaching theory combined with PBL teaching mode was applied in the group. After the residency training, the teaching effect of the two groups of training residents was evaluated by theoretical examination, practical skill operation examination and questionnaire survey. SPSS 22.0 was used to conduct t test. Results:The results of theoretical assessment and practical skills operation assessment of students in the study group were better than those in the control group, and the difference was statistically significant ( P<0.05). The subjective satisfaction of the training residents and the tutors were scored respectively. The results showed that the scores of residents in the study group were higher than those in the control group, the difference was statistically significant ( P<0.05). The subjective satisfaction score of residents on the assessment results of this stage showed that residents in the study group had higher scores than the control group, with statistical significance ( P<0.05). The tutor's subjective satisfaction score of the assessment results at this stage showed that the scores of the residents in the study group were higher than those in the control group, and the difference was statistically significant ( P<0.05). Conclusion:The combination of Bloom target teaching theory and PBL teaching mode can improve the theoretical and practical operation ability of students in respiratory department, improve their learning initiative, enthusiasm and teaching satisfaction, and then improve the teaching quality.
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Objective To understand the knowledge of tuberculosis in general hospital patients with respiratory diseases.Methods Face to face questionnaire survey 821 respiratory patients, the main contents include: the tuberculosis awareness, common symptoms of tuberculosis, tuberculosis with or without contagious, persistent cough expectorant willing to go to where the treatment of tuberculosis, national policy, treatment of the course of treatment, tuberculosis prevention measures, and whether the knowledge of tuberculosis drug resistance.Results 92.1% of patients were aware of TB and 98.7% of patients knew TB was contagious, and 99% knew that TB was transmitted by the respiratory tract.Only 4.5% of patients with symptoms appear willing to go to tuberculosis treatment of patients.94.9% of the patients were aware of a specific TB control facility, 85% knew that the basic TB treatment was free, 99% thought to be good treatment of tuberculosis patients, 55% of patients know that tuberculosis treatment for a long time, to regular medication.30% of people know that mycobacterium tuberculosis resistance.90% of patients know to isolate tuberculosis patients, 40% of patients that protect susceptible populations, and 95% believed that BCG could prevent tuberculosis.Conclusion Patients have a certain understanding of tuberculosis, the timely treatment of indifference to the treatment of treatment is probably not impressed, very little knowledge of tuberculosis resistance.
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Objective To detect the expressions of interleukin-11 (IL-11) and interleukin-11 receptorα(IL-11Rα) in non-small cell lung cancer (NSCLC) cell lines, and explore their clinical significances. Methods The expressions of IL-11 and IL-11Rαin NSCLC cell lines A549, H2228, healthy lung small airway epithelial cell (SAEC) line cytoplasm, cell membrane and nucleus were detected by Western blot. Results The expressions of IL-11 and IL-11Rα were low in the cell membrance and nucleus (cell membrane: IL-110.04± 0.03, IL-11Rα0.05±0.03; nuclear: IL-110.45±0.19, IL-11Rα0.07±0.02;P<0.01); The expressions of IL-11 and IL-11Rα in A549 and H2228 cell lines were significantly increased compared with those of SAEC cell lines in the cell membrance and cytoplasm (P< 0.01); Among the A549 cell lines, the expressions of IL-11 and IL-11Rα in cell nucleus were much higher than those of the cell membrance and cytoplasm (P< 0.01). Among the H2228 cell lines, the expression of IL-11 in cytoplasm was the highest and the expression of IL-11Rα was the highest in the cell nucleus (P< 0.01). Conclusion The expressions of IL-11 and IL-11Rαare high in NSCLC cell lines, and it is good for the screening and early diagnosis of lung cancer by detecting the expressions of IL-11 and IL-11Rα.
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Objective To understand antimicrobial resistance and therapeutic efficacy of imipenem/cilastatin and meropenem for treatment of multidrug-resistant Pseudomonas aeruginosa (MDRPA)from patients with mechanical ventilation.Methods From January 2010 to December 2015,78 patients with mechanical ventilation and isolated MDRPA from sputum cultures were selected and divided into imipenem/cilastatin (n=44)and meropenem(n=34) treatment groups,basic condition,time of emergence of drug resistance,and therapeutic efficacy of antimicrobial agents between two groups were compared.Results The basic data of two groups were comparable,before treat-ment by imipenem/cilastatin and meropenem,resistance rates of Pseudomonas aeruginosa (P .aeruginosa )to quinolones,ceftazidime,piperacillin,and amikacin were not significantly different (all P >0.05).After patients received antimicrobial agents for 6 days,difference in antimicrobial resistance between imipenem /cilastatin and meropenem treatment groups were not significantly different (22.73% vs 8.82%,P >0.05).On the 8th,10th,and 12th day of treatment,resistance rates of imipenem treatment group were 40.91%,77.27%,and 97.73%, respectively,which were all higher than meropenem treatment group (17.65%,32.35%,44.12%,respectively,all P <0.05).After the treatment with different antimicrobial agents,the average time for the emergence of resistance in imipenem/cilastatin and meropenem treatment group were 9.0 days and 13.5 days respectively.Therapeutic efficacy between two groups was not significantly different (64.71% vs 74.19%,P =0.41).Conclusion Compared with meropenem,imipenem/cilastatin shows higher risk for the emergence of drug resistance during therapy of P . aeruginosa infection in patients with mechanical ventilation,there is no significant difference in therapeutic efficacy between two groups of patients after 7 days of treatment.
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Objective To explore the prevalence and influential factors of chronic respiratory system diseases among resi-dents over 1 5 years old in Hubei province and provide evidence for disease prevention.Methods During October to November in 2013,through stratified cluster sampling,we sampled 20 cities or counties.The survey included the the general condition of family, individual,chronic diseases.Results A total of 28 563 residents answered the questionnaire and 423 of them reported chronic re-spiratory system diseases by themselves.The prevalence rate was 14.8‰.These included 229 cases with COPD(54.1%),44 cases with asthma(10.4%),35 cases with chronic pharyngolaryngitis(8.3%)and 1 1 5 cases with other chronic respiratory system disea-ses(27.2%).In urban and rural area,the prevalence rate were 13.6‰ and 1 5.7‰ respectively.Multivariate logistic analysis showed that gender,age,economic status and medical insurance are influential factors of chronic respiratory system diseases.Conclusion Prevalence rate of chronic respiratory system diseases among residents over 1 5 years old in Hubei province was slightly increased and disease control measures should be brought out.
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Objective To explore the value of minute ventilation recovery time (VERT) as a weaning predictor in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD).Methods A prospective study was performed from March 2008 to July 2012.Fifty-two COPD patients under mechanical ventilation for more than 48 hours in our RICU tolerated a spontaneous breathing trial (SBT) and were ready for planned extubation.After SBT,these patients were placed back on their pre-SBT ventilator settings for up to 25 minutes,during which VERT was obtained.VERT was defined as the time for minute ventilation to return to baseline measured before SBT.Respiratory rate,tidal volume,minute ventilation and respiratory rate/tidal volume ratio were also obtained before SBT and just after SBT.Arterial blood gas data were measured and recorded before weaning.According to the weaning outcome,the patients were classified as successful group (40 cases) or failed group (12 cases).VERT and other quantitative variables were compared using t test.A multiple logistic regression was performed to explore possible factors associated with the weaning outcome.The sensitivity and specificity of VERT for predictive capacity in weaning were assessed using ROC cure.Results VERT and respiratory rate after SBT were significantly different between two groups.Multiple logistic regression revealed that VERT was the only predictor associated with weaning outcome (b =0.282,P ＜0.001).The area under ROC curve for VERT was 0.957 (95％ CI:O.907-1.008).With a cut-off value of 10.5 minutes,the sensitivity and specificity of VERT for predicting weaning failure were 1.0 and 0.85,respectively.Conclusions VERT may be a new predictor for extubation and determination of mechanical ventilation weaning in patients with COPD.VERT is a variable to be easily measured thereby being conveniently used in clinical practice.
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Objective To explore the changes of serum lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) and the level of lipids in patients with obstructive sleep apnea hypopnea syndrome (OSAHS).Methods A total of 94 candidates with sleep disorders between January-July 2011 at outpatient department were monitored with polysomnography.According to apnea-hypopnea index (AHI),they were divided into mild-to-moderate OSAHS (5 ≤ AHI ≤ 30) (n =27),severe OSAHS (AHI ＞ 30) (n =37) and normal control groups (AHI ＜ 5) (n =30).After polysomnography,their blood samples were obtained to measure the levels of serum LOX-1,triglycerides (TG),cholesterol (TC),high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C).Results The serum level of LOX-1 in severe OSAHS group was significantly higher than that in the mild-to-moderate and control groups (P ＜ 0.01).The serum level of LOX-1 in OSAHS patients was positively correlated with AHI and longest apnea time (LAT)(r =0.645 & 0.501 respectively,both P ＜ 0.01) and was negatively correlated with SaO2 (r =-0.647,P ＜0.01).No significant difference existed in serum lipids in all groups (P ＞ 0.05).Conclusions Intermittent hypoxia caused by OSAHS increases the level of LOX-1 to further promote the formation and development of atherosclerotic in patients with OSAHS.The levels of lipid can not effectively predict the severity of lipid metabolism disorder in patients with OSAHS.
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Objective: To explore the effects of pulmonary rehabilitation on exercise tolerance ability. Methods:Fifteen (10 males,5 females)stable COPD patients, entered into 48 weeks of rehabilitation program. The lung function, 6 minutes walk distance(6MWD) were measured at pre, post and first post-maximal exercise training. Results: There was no significiant change in FEV1, FEV1/predict and FEV1/FVC at pre, post and first post-maximal exercise training in COPD patients. 6MWD significantly increased in COPD patients after 48 weeks exercise training program. There was no significant change in baseline and first post-maximal exercise training in COPD patients. Conclusion:There were no significant changes in parameters of lung function before and after training. The exercise tolerance in COPD patients was significantly improved by 48 weeks exercise training.
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Objective To investigate the expression of MCM2 and its prognostic significance in non-small cell lung cancer (NSCLC). Methods The expression of MCM2 was measured by immunohistochemistry in 73 cases of NSCLC and 10 cases of normal lung tissue. The correlations between the expression of MCM2 and clinic-opathological parameters and prognosis were investigated. Results There was no MCM2 expression in normal lung tissue and positive rate of MCM2 expression was 87.7% in NSCLC. The difference between the two groups was significant (P<0.001). The expression of MCM2 in poorly differentiated NSCLC patients was significantly higher than that in moderately- and well-differentiated NSCLC patients (P=0.008). The expression of MCM2 in patients with squamous carcinoma was higher than that in patients with adenocarcinoma (P=0.005). The hazard ratio was significantly higher(RR=3.389, 95 % CI=1.803-7.146,P<0.001), and the accumulated survival rate was significantly lower (P=0.001) in NSCLC patients with higher MCM2 expression than that of lower expression. MCM2 was independent prognostic factor of NSCLC patients (P=0.041). Conclusion MCM2 could reflect the reproductive activity of NSCLC and has some clinical significance for assessing the development and prognosis of NSCLC. MCM2 was a potential target for future treatment.
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Objective To explore expression of the minichromosome maintenance 2 (MCM2)protein and the mucin-like cell surface adhesion molecule CD24 in non-small cell lung cancer (NSCLC) and their relationship with its prognosis. Methods Seventy-three patients of NSCLC diagnosed for the first time and received surgical treatment in Xuanwu Hospital, Beijing were selected for the study. Expression of the MCM2 and CD24 in pathological specimens of the patients was measured by immunohistochemistry and their relationship with its prognosis was analyzed retrospectively. Results High-level expression of the MCM2 and CD24 was seen in 42 and 54 of 73 NSCLC patients, accounting for 57. 5 percent and 74. 0 percent,respectively. Risk of death for the patients with high-level expression of the MCM2 or the CD4 was significantly higher as compared to those with low-level expression ( P ＜ 0. 05 ). Risk of death for patients with both high-level expression of the MCM2 and CD24 was significantly higher than that in those with only high-level expression of the MCM2 or the CD24 (HR =2. 59, 95%CI 1.40 -4. 80, P=0. 002) and in those with both low-level expression of them ( HR = 15.32, 95 % CI = 2.07 - 113.41, P = 0. 008 ). But there was no significant difference in risk of death between patients with high-level expression of the MCM2 or CD24 and those with low-level expression of both of them ( HR = 5. 60, 95% CI 0. 79 - 44. 82, P = 0. 083 ), and cumulative survival rate of patients with both high-level expression of the MCM2 and CD24 was significantly lower than those with only high-level expression of the MCM2 or the CD24 ( P = 0. 001 ). Conclusions Both expression of the MCM2 and the CD24 are independent prognostic factors for NSCLC and combined detection of the two markers have higher prognostic value for it.
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@#Objective To investigate the evaluation of cardiopulmonary exercise test (CPET) in the patients with chronic obstructive pulmonary disease (COPD), and the relationship with the pulmonary function test (PFT). Methods 26 COPD patients and 30 normal controls were examined with CPET and PFT. Results The parameters of CPET, including maximum oxygen uptake (VO2max), anaerobic threshold (AT), maximum minute ventilation (VEmax) and breathing reserve (BR) were lower in COPD group than those in control group (P<0.05). There were no significant differences in Wmax, oxygen pulse (O2pulse) between two groups (P>0.05). VO2max, AT, VEmax and BR were positively correlated with forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF) in COPD group （P<0.05）, but were not correlated with forced vital capacity (FVC) and FEV1/FVC (P>0.05).Conclusion The pulmonary function of COPD patients can be evaluated with CPET, especially VO2max, AT, VEmax and BR.
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Objective To investigate the changes in serum level of vascular endothelial growth factor (VEGF), nitric oxide (NO), erythropoietin (EPO) and plasma level of carbon monoxide (CO) in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and their clinical significance. Methods Sixty-four patients diagnosed as OSAHS by polysomnography (PSG), were divided into two groups according to apnea-hypopnea index (AHI), 20 in mild group [5/h≤AHI≤20/h, with a mean of (12± 5)/hi and 44 in moderate-severe group[AHI > 20/h, with a mean of (63±23)/h]. Blood samples were obtained from all the patients after PSG for measurement of levels of serum VEGF, NO and EPO and plasma CO. Results Levels of serum VEGF [(101±91) ng/L], NO [(10.3±3.3) μmol/L]and plasma CO [(0.56±0. 35) mg/L]in moderate-severe OSAHS group were significantly higher than those in mild group (all P <0.05). There was no significantly difference in serum level of EPO between the two groups (P> 0.05). Levels of serum VEGF, NO and plasma CO in OSAHS patients positively correlated with AHI and percentage of time with percutaneous arterial blood oxygen saturation lower than 0. 9 (SLT90) of all sleep time (all P < 0. 05), but reversely correlated with the lowest arterial blood oxygen saturation (LSaO2) at night (P>0.05). No correlation between EPO and all the indicators was found (P>0.05). Multiple linear regression analysis showed that LSaO2 was an independent risk factor to affect levels of serum VEGF and plasma CO (R2=0.198, P=0.001, and R2=0.210, P=0.000, respectively) and SLT90 was an independent risk factor to affect serum level of NO (R2= 0. 148, P=0.004) in OSAHS patients. Conclusion Hypoxia at night is a main cause leading to increased level of serum VEGF, NO and plasma CO in OSAHS patients.
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Objective To study the relationship between oxidative stress and endothelial cell apoptosis in patients with obstructive sleep apnea-hypoventilation syndrome (OSAHS). Methods Sixth-seven patients definitely diagnosed by potysomnography (PSG) as OSAHS were divided into three groups according to their apnea-hypoventilation index (AHI), 14 in mild group (5 < AHI≤20), 21 in moderate group (20 < AHI≤40) and 32 in severe group (AHI 40). And, 18 healthy persons (AHI <5) were recruited as controls. Blood samples were obtained form all of them after PSG performance for measuring apoptotic endothelial cells (CD146AnnV+) and serum levels of superoxide dismutase (SOD) and malondialdehyde (MDA). Results Serum level of MDA and CD146AnnV+ in moderate and severe OSAHS group were significantly higher than those in control group (all P < 0.05). Serum level of SOD in moderate and severe OSAHS group was significantly lower than that in control group (P < 0.05). CD146AnnV+ correlated positively with AHI, the longest apnea time (LAT) and oxygen desaturation index (ODI) (r = 0.778, 0.609 and 0.689, respectively, all P < 0.05) and correlated reversely with saturation of arterial blood oxygen at night (SaO2min) (r =-0.635, P < 0.01). CD146AAnnV+ correlated positively with serum level of MDA (r = 0. 698, P < 0.01), and correlated reversely with serum level of SOD (r =-0.705, P < 0.01). Results of linear multivariate regression analysis showed that AHI, serum levels of SOD and MDA were independent risk factors for endothelial cells apoptosis in patients with OSAHS. Conclusions There existed oxidative stress due to intermittent hypoxia in patients with OSAHS, which could be one of the major causes in exacerbating endothelial damage.
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Objective The aim of this study is to evaluate clinical application of BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index in patients with chronic obstructive pulmonary disease (COPD). Methods Forty patients with stable COPD in Xuanwu Hospital of Beijing during September 2003 to December 2007, were recruited in the study, including 25 men and 15 women, aged 38 to 85 years (with a mean of 62 ± 13 years). BODE index was measured for each patient, one year and three years after recruitment, respectively. Severity of COPD, including number and duration of episodes, length of each hospital stay and times of hospitalization due to acute exacerbation of COPD (AECOPD), were recorded. All data were statistically analyzed with SPSS 13.0 software for windows. Results ①There was a remarkable difference in COPD severity between patients with BODE score equal to or greater than five and these with less than five (P <0.01 ). ①BODE score inversely correlated with forced expired volume at the first second ( FEV1 ) in COPD patients (P < 0.01 for those with BODE score equal to or greater than five and P <0.05 for these with BODE score less than five, respectively). ③BODE score positively correlated with number and duration of acute exacerbation, length of hospital stay and times of hospitalization due to AECOPD (P <0. 01 for those with BODE score equal to or greater than five and P < 0. 05 for those with BODE score less than five, respectively). For patients with COPD, their BODE score in the first year positively correlated with that in the third year ( r = 0.834, P < 0.01 ). Conclusions BODE index is a better indicator to evaluate their condition severity in patients with COPD.
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@#Objective To investigate the evaluation of high-resolution computed tomography (HRCT) in patients with chronic obstructive pulmonary diseases (COPD), and the relationship with the pulmonary function test and BODE index.Methods 32 COPD patients and 22 normal controls were examined by pulmonary function test (PFT) and HRCT. The data of two groups were compared.Results The volume and pixel index (PI) in forced expiration were higher in the COPD group than those in the control group ( P<0.01), but there was no significant difference in Vin between two groups ( P>0.05). In the COPD group, Vex and Vin were negatively correlated with FEV1/FVC ( P<0.05) respectively. There were no correlation between Vin, Vex and FEV1% pre in the COPD patients ( P>0.05) respectively. Vin and Vex were not correlated with BODE index (all P>0.05) respectively. The ratio of Vex/Vin was positively correlated with BODE index ( P<0.05), and not correlated with FEV1/FVC ( P>0.05). PI910ex was positively correlated with BODE index ( P<0.01), and negatively correlated with FEV1%pre, FEV1/FVC (all P<0.05) respectively.Conclusion The pulmonary function of COPD patients can be evaluated by HRCT, especially by PI910ex.
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Objective To compare FEV1 with BODE in evaluating COPD.Methods Forty-one stable COPD patients,23 males and 18 females,with mean age of 58.8 years,were evaluated for FEV1 and BODE scores,the number and duration of acute exacerbations of COPD(AECOPD),number of admissions and duration of hospitalization caused by AECOPD,and sputum culture.All data were statistically analyzed with SPSS 11.0 for Windows.Results There was a remarkable difference in disease severity between the group with FEV1≥1 L and BODE score
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Objective To asscess cognitive changes of patients with Obstructive Sleep Apnea-Hypopnea Syndrome(OSAHS)by the Expansive Scale of Dementia(ESD),and to compare ESD to Mini Mental Status Examenation(MMSE)in cognitive function.Methods 90 OSAHS patients were investigated in our study.All patients were divided into three groups,according to apnea-hypopnea index(AHI),including mild group,moderate group and severe group.The cognitive function was evaluated by MMSE and ESD.Results The parameters,including AHI,Longest apnea time(LAT)and percentage of time spend when oxygen saturation lower than 0.9(SLT 90%) in severe OSAHS group were significantly higher than those in mild and moderate groups(P0.05).The total score of MMSE and subtest scores of MMSE in memory,attention,calculation and short-and long-term memory were significantly lower in severe OSAHS group than those in mild and moderate groups(P0.05).Conclusion There was the obvious decrease in cognitive function in patients with severe OSAHS,especially in leaning,memory,calculation and constructive function.Both ESD and MMSE could be used to evaluate the cognitive function in OSAHS patients,especially ESD.
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0.05).The blood gas analysis(BGA) and pulmonary function test(PFT) were performed in patients with stable COPD.The cognitive function was evaluated by ESD in both patients with stable COPD and healthy persons as control.The patients were divided into different groups by BGA and PFT(FEV1/Pred).Results:The total score of ESD and the subtest scores of ESD in leaning,memory,calculation,constructive function were obviously lower in the patient group than those in the control group(The mean difference of the total score was 16,with the two groups' total scores as 208.1?17.6/224.3?10.6,t=5.19,P