Objective To evaluate the effect of modern comprehensive three-dimensional teaching method in clinical practice of respiratory medicine. Method The problem based teaching method PBL (problem-based learning), the standardized patient-based practice SPE/Xs (standardized patient experiences/exam) and Mini clinical examination practice Mini-CEX (Mini clinical examination exercise) method and other methods were organically combined and used in respiratory medicine clini-cal practice, and it was named“modern comprehensive three-dimensional teaching mode”. 60 students were randomly divided into the modern comprehensive three-dimensional teaching method group (30 students) and the traditional teaching method (SBL) (30 students), using the modern com-prehensive three-dimensional teaching method and the SBL breathing internal medicine practice teaching respec-tively. After the teaching, the methods of performance testing and questionnalre survey were used to evaluate the teaching effect of two groups of students. SPSS software was used to compare t test. Results The test results of modern three-dimensional integrated teaching method group was (86.91±4.77), higher than that of the control group (79.00±7.51) points (t=12.4, P=0.026 0). In the subjective questions (such as discourse analysis problem and case), modern three-dimensional integrated teaching group (47.63± 2.14) points is obvi-ously superior to the traditional group (36.00±6.71) points (t=21.6, P=0.001 9). According to the results of the survey, the modern comprehensive teaching method can improve students' subjective initiative and enthusiasm for learning, improve students' ability of comprehensive analysis, promote the formation of clinical thinking, and help students master the basic knowledge and basic skills of respiratory diseases. Conclusions In the respiratory medicine teaching, implementation of modern comprehensive three-dimensional teaching method is helpful to improving the teaching effect.

Objective In order to improve diagnosis of pulmonary thromboembolism(PTE),the clinical features of pulmonary embolism between older and younger patients were compared.Methods Totally 105 patients(57 older and 48 younger)with diagnosed PTE were assessed retrospectively.Results There were more risk factors in the elderly as compared with younger group.Phlebitis was the major risk factor in both groups.Other risk factors,such as COPD,immobilization,malignancy and cardiac disease,were more frequent in the elderly;whereas in younger patients,intravenous drug injection and genetic factors were more frequent.Chest pain and hemoptysis were less frequent in older patients whereas syncope occurred more often in the older group."Triplicate symptoms" (including dyspnea,chest pain and hemoptysis)occurred more often in the younger group.Massive PTE occurred more often in the older patients.Severe complications were more frequent in cTnT-positive patients.Conclusion There are more risk factors in the elderly.The clinical presentation of PTE is often atypical in elderly patients,and prone to develop massive PTE.cTnT(Cardiac troponin T)is an independent predictor of prognostic implications in patients with confirmed PTE.

OBJECTIVE:To study improvement effect of modified mahuang chanyi decoction on allergic rhinitis(AR)model guinea pigs and its mechanism. METHODS:32 guinea pigs were randomly divided into normal group (0.9% Sodium chloride in-jection),model group (0.9% Sodium chloride injection),experimental [Modified mahuang chanyi decoction,5.18 g (medicinal materials)/kg] group and control [Fluticasone propionate nasal spray,50 μg/(guinea pig·d)] group. Except for normal group,other groups received ovalbumin 30 mg and calmogastrin 30 mg intraperitoneally to induce AR model. Except for control group,other groups were given relevant medicine intragastrically,twice a day for consecutive 15 d. Nasal symptoms of guinea pigs were ob-served and recorded,and then analyzed and scored. The protein expression of nasal mucosa SHP-1 was detected by immunohisto-chemistry,the serum contents of IL-4 and IFN-γ were determined by enzyme-linked immunosorbent assay. RESULTS:Compared with normal group,model group suffered from AR symptom,and nasal symptoms score was increased;and the protein expression of nasal mucosa SHP-1 and the serum content of IL-4 increased,while the content of IFN-γ decreased(P<0.05). Compared with model group,AR symptom of experimental group and control group were improved;nasal symptoms score,the protein expression of nasal mucosa SHP-1 and the serum content of IL-4 decreased while the content of IFN-γ increased(P<0.05). CONCLUSIONS:Modified mahuang chanyi decoction shows certain improvement effect on AR,and its mechanism is associated the decrease of IL-4 content and the increase of IFN-γcontent in serum.

Objective To determinate the heavy metal cadmium content in rice to ensure food safety.Methods Several brands and batch numbers of rice were collected and divided into groups A and B.Group A contained 24 pieces of rice from the canteens,and group B involved in 22 pieces from the farm product markets.Cadmium content in rice was detected quantitatively with X-ray fluorescence spectrometer,and then evaluated according to GB 2762-2012 which determined rice was not qualified in case cadmium content was more than 0.2 mg/kg.Results Group A had cadmium content between 0.00 and 0.477 mg/kg,the times of ultra standard being 2.385 and the disqualification rate being 29.2％ (7/24),and group B had cadmium content between 0.065 and 0.619 mg/kg,the times of ultra standard being 3.095 and the disqualification rate being 68.2％ (15/22).Excessive cadmium content in rice occurred in both canteens and markets,while the canteens was better than the markets.Conclusion X-ray fluorescence spectrometer detects cadmium content in rice rapidly and simply,and is worthy promoting in elementary facilities.

Objective Prognostic value of cardiac troponin T,echocardiography and ECG in patients with confirmed pulmonary embolism were evaluated. Methods 105 consecutive patients with confirmed PE were enrolled in this retrospective study. PE was confirmed by pulmonary angiography,lung scan or echocardiography and subsidiary analyses, cTnT was measured within 24 hours after admission. ECG and ECHO were recorded within 24 hours after admission. Results ECG signs of acute right ventricular strain are not predictors of mortality and severe complications in patients with confirmed PE. Only right ventricular dilation but not pulmonary hypertension detected at echocardiography in patients with acute PE is an independent risk factor for fatal outcome. There were significant differences in right ventricular dysfunction,massive PE and severe complications between the troponin-positive group and the troponin-negative group. In logistic regression analysis,cTnT is an independent predictor of severe complications. Furthermore,high cTnT was significantly associated with severe PE. Conclusion Right ventricular function is an important prognostic factor for pulmonary embolism. Echocardiographically detected right ventricular dysfunction can be used to assess the prognosis of PE. Elevation of cTnT was significantly associated with right ventricular dysfunction,and can be used to assess the prognosis of PE. ECG signs of acute right ventricular strain were not specific, so can not be used to assess the prognosis of PE.

Objective To explore the difference between T cells in the synovial fluid and peripheral blood in patients with rheumatoid arthritis(RA). Method Samples from 22 patients were studied. The differentiation and activation markers expressed on T cell surface were detected by immunofluorscence using flow cytometer. The specific proliferation of collagen Ⅱ and heat shock protein 70 was analyzed using standard 3H-TdR incorporation method. Restricted V beta usage of these T cell was analyzed by semi-quantitied RT-PCR. Results The majority of the T cell subsets in the synovial fluid were demonstrated to be CD4 and CD8 positive cells in which (40?10)% were CD4 positive and (36?16)% were CD8 T cells respectively. The ratio between CD4 and CD8 was much lower than that found in the PBL of RA patients. The percentage of CD3+/CD25+ T cells was (16?6)%. The specific proliferation of collagen Ⅱ and HSP70 to CD3+/CD25+ T cell was higher than that of CD3+/CD25+ negative T cells. The T cell receptor expressed on the T cells from both peripheral blood and synovial fluid were tested for ?? TCR (70?26)%. However, the T cells in the synovial fluid showed V?14,16 and 17 restriction. Conclusion The data here reported indicates that T cell subsets in the synovial fluid and peripheral blood circulation in patients with rheumatoid arthritis are different. The T cells in the synovial fluid demonstrates more activation and higher reactivation to collagen Ⅱ and HSP70. The TCR of T cells showes V?14,16 and 17 restriction.

Objective? To explore the effects of health education based on "information-motivation-behavioral skills" (IMB) model on health behavior among soldiers with urolithiasis in the plateau. Methods? From January 2016 to May 2017, we selected 160 soldiers with urolithiasis providing logistic services in the plateau with altitude of more than 3 000 m at the 940th Hospital of Logistic Services Troops of the Chinese People's Liberation Army as subjects by convenience sampling. All of the patients were divided into experimental group and control group with the random number table, 80 cases in each group. Control group carried out routine health education, while experimental group implemented health education based on IMB model. After intervention, we compared the health belief, health behavior and recurrence rate of calculi of soldiers between two groups. Results? Six months after intervention, the total scores of health belief and health behavior of experimental group were (140.22±12.90) and (149.44±14.18) higher than those of control group with statistical differences (P＜0.05). The recurrence rates of calculi of experimental group in 6 and 12 months were lower than those of control group with statistical differences (χ2=7.761,P＜0.05). Conclusions? Health education based on IMB model makes soldiers change healthy perception into actual behavior and maintain healthy behavior in daily life to reduce the recurrence rate of urinary calculus and improve the combat capability of troops.

AIM:To compare the recovery of psy-chomotor function after intravenous anesthesia with remazolam or propofol compound alfentanil in patients undergoing painless gastrointestinal en-doscopy.METHODS:78 patients undergoing pain-less gastrointestinal endoscopy were randomly di-vided into group RA and group PA.Remiazolam or propofol combined with alfentanil were given intra-venously in group RA or group PA.The blood pres-sure,heart rate,respiratory rate and saturation of puls oxygen were recorded before procdure(T1),during checking(T2),awaking from anaesthesia(T3)and at discharging from PACU(T4).Psychomo-tor function,as measured by the Trieger's dot test(TDT)and digit symbol substitution test(DSST),were evaluated before anesthesia(T1),at discharg-ing from PACU(T4),1 h(T5)and 2 h(T6)after checking.RESULTS:From assessment of the TDT,number of dots missed(NDM),maximum distance of dots missed(MDDM)and average distance of dots missed(ADDM)at T4,T5 were significantly lower than those at T1 in two groups.The comple-tion rates and accuracy rates of DSST at T4,T5 were significantly lower than those at T1.Results of TDT and DSST at T6 were not significantly differ-ent to those at T1.The results of NDT,MDDM and ADDM at T4,T5 in group RA were significantly low-er than those in group PA.The completion rates and accuracy rates of DSST at T4,T5 in group RA increased significantly compared with group PA.Compared to group PA,the incidence of hypoten-sion was significantly lower in group RA.There was no significant difference in the incidence of respira-tory depression between the two groups.CONCLU-SION:Psychomotor function was fully recovered 2 h after surgery when remazolam compound alfent-anil was used for painless gastrointestinal endosco-py.Compared with propofol,psychomotor function recovery in the remazolam group was faster and there were fewer adverse effects after surgery in group RA.

Background::In vitro fertilization (IVF) has emerged as a transformative solution for infertility. However, achieving favorable live-birth outcomes remains challenging. Current clinical IVF practices in IVF involve the collection of heterogeneous embryo data through diverse methods, including static images and temporal videos. However, traditional embryo selection methods, primarily reliant on visual inspection of morphology, exhibit variability and are contingent on the experience of practitioners. Therefore, an automated system that can evaluate heterogeneous embryo data to predict the final outcomes of live births is highly desirable. Methods::We employed artificial intelligence (AI) for embryo morphological grading, blastocyst embryo selection, aneuploidy prediction, and final live-birth outcome prediction. We developed and validated the AI models using multitask learning for embryo morphological assessment, including pronucleus type on day 1 and the number of blastomeres, asymmetry, and fragmentation of blastomeres on day 3, using 19,201 embryo photographs from 8271 patients. A neural network was trained on embryo and clinical metadata to identify good-quality embryos for implantation on day 3 or day 5, and predict live-birth outcomes. Additionally, a 3D convolutional neural network was trained on 418 time-lapse videos of preimplantation genetic testing (PGT)-based ploidy outcomes for the prediction of aneuploidy and consequent live-birth outcomes.Results::These two approaches enabled us to automatically assess the implantation potential. By combining embryo and maternal metrics in an ensemble AI model, we evaluated live-birth outcomes in a prospective cohort that achieved higher accuracy than experienced embryologists (46.1% vs. 30.7% on day 3, 55.0% vs. 40.7% on day 5). Our results demonstrate the potential for AI-based selection of embryos based on characteristics beyond the observational abilities of human clinicians (area under the curve: 0.769, 95% confidence interval: 0.709–0.820). These findings could potentially provide a noninvasive, high-throughput, and low-cost screening tool to facilitate embryo selection and achieve better outcomes. Conclusions::Our study underscores the AI model’s ability to provide interpretable evidence for clinicians in assisted reproduction, highlighting its potential as a noninvasive, efficient, and cost-effective tool for improved embryo selection and enhanced IVF outcomes. The convergence of cutting-edge technology and reproductive medicine has opened new avenues for addressing infertility challenges and optimizing IVF success rates.

Objective:To investigate the correlation between serum uric acid levels and thyroid hormones in hospitalized elderly gout patients.Methods:A total of 646 hospitalized gout patients, including 616 males and 30 females, aged(68.8±5.1)years, who were hospitalized at the Department of Gout, Chu Hsien-I Memorial Hospital from April 2014 to December 2019, were retrospectively analyzed.Clinical information was collected and relevant biochemical tests were conducted.Serum uric acid (SUA)levels were divided into quartiles and their associations with thyroid hormone levels were analyzed.Results:With the increase of SUA, body mass index, the prevalence of obesity, the prevalence of dyslipidemia, and the prevalence of fatty liver, the number of involved joints, cholesterol, low-density lipoprotein cholesterol, triacylglycerol, and homeostasis model assessment trended upward significantly( P<0.05); FUA showed a downward trend( F=9.42, P>0.05). The prevalence of subclinical hypothyroidism in older patients was 11.3%(73 cases). With the increase of SUA, the prevalence of subclinical hypothyroidism and free triiodothyronine levels showed an upward trend, whereas free thyroxine levels showed a downward trend( P<0.01). Conclusions:In elderly gout patients, the prevalence of subclinical hypothyroidism increases with SUA levels.Hyperuricemia and multiple metabolic disorders are independent risk factors for subclinical hypothyroidism in these patients.