Objective To analyze the effect of salmeterol Lo fluticasone combined with montelukast on the treatment of the elderly patients with severe bronchial asthma. Methods According to the order of admission, 90 elderly patients with moderate or severe bronchial asthma treated in our hospital from October 2015 to October 2016 were divided into two groups: the study group (n=45) and the control group (n=45). The control group were given salmeterol and fluticasone. The study group were received montelukast on the basis of the control group. The therapeutic effects and pulmonary function in the two groups were compared. Results The total effective rate in the study group was significantly higher than that in the control group, the lung function was significantly better than that in the control group, the differences was statistically significant (P<0.05). Conclusion The clinical efficacy is significant which salmeterol fluticasone combined with montelukast was used on the treatment of elderly patients with moderate and severe bronchial asthma , pulmonary function is improved significantly, which is worthy of reference and promotion.

Objective To evaluate the clinical efficacy of tiotropium combined with salmeterol/fluticasone on the treatment of the patients with asthma COPD overlap syndrome. Methods 122 patients with asthma COPD overlap syndrome were divided into 2 groups by randomized envelope, the experimental group and the control group. The experimental group were given tiotropium bromide combined with salmeterol/fluticasone. The control group were received compound ipratropium bromide combined with salmeterol/fluticasone. The clinical effect was observed. Results Before treatment, there was no significant difference in lung function between the two groups. After treatment, the improvement of pulmonary function indexes in the experimental group was significantly higher than that in the control group (P<0.05). And the number of acute attack and attack time in the experimental group were also better than those in the control group (P<0.05). Conclusion Tiotropium combined with Shah Mette Lo/fluticasone is effective on the treatment of asthma COPD overlap syndrome, and has some clinical advantages in improving lung function and reducing the frequency of attack.

Objective To investigate the status quo and its influencing factors of nurses'organizational silence in 3 Grade A general hospitals.Methods Convenient sampling method was used to investigate clinical nurses in 3 Grade A general hospitals in Xi'an from April to August 2023 by general data questionnaire,nurses'organizational silence questionnaire and hospital magnetic factor scale.Multiple linear regression was used to analyze the influencing factors of organizational silence.Results A total of 855 nurses completed the study.The total silence score of nurses was(56.33±8.55);The total score of hospital magnetic level was(107.63±12.85).There was a negative correlation between nurse tissue silence and hospital magnetic level(r=-0.318,P<0.01).Hospital magnetic level,age,job title and working time were the influential factors of nurses'organizational silence(all P<0.001),which together explained 62.60%of the variation.Conclusions The silence of nurses'tissue and the level of hospital magnetism are in the low-medium level.Nurses are younger in age,lower in professional title,shorter in nursing age and lower in hospital magnetism level,the higher the tissue age level is,the nursing managers can reduce the tissue silence of nurses by improving the hospital magnetism level.

Objective To investigate the relationship between serum levels of hepatocyte growth factor(HGF)and lipoxygenase-4(LXA4)in patients with acute exacerbation of bronchiectasis and the severity of the disease,and their evaluation value for the prognosis.Methods A total of 138 patients diagnosed with and treated for acute exacerbation of bronchiectasis between January 2019 and January 2021 in the hospital were selected as acute exacerbation group.Based on the bronchiectasis severity index(BSI score),patients were di-vided into mild group(40 cases),moderate group(46 cases),and severe group(52 cases).Additionally,pa-tients were categorized into a good prognosis group(85 cases)and a poor prognosis group(53 cases)based on their clinical outcomes.70 stable bronchiectasis patients treated concurrently were selected as the stable stage group.Furthermore,70 healthy individuals who underwent physical examinations during the same period was included as the control group.Serum HGF and LXA4 levels were measured by enzyme-linked immunosorbent assay.Logistic regression model was used to explore the factors affecting the prognosis of patients with acute exacerbation of bronchiectasis.The predictive effect of serum HGF and LXA4 levels on the prognosis of pa-tients with acute exacerbation of bronchiectasis was analyzed by receiver operating characteristic(ROC)curve.Results Compared with the stable stage group and the control group,the acute exacerbation group had higher serum HGF levels and lower LXA4 levels(all P＜0.05).The more severe the condition was in the a-cute exacerbation group,the higher the serum HGF level and the lower the LXA4 level.Compared with the good prognosis group,the poor prognosis group had lower levels of hemoglobin,albumin,and serum LXA4,while the number of acute exacerbations,proportion of severe BSI scores,and serum HGF levels were higher(all P＜0.05).In the acute exacerbation group,the more severe the disease,the higher the serum HGF level and the lower the LxA4 level.The number of acute exacerbations(OR=1.185,P＜0.001),BSI score(OR=1.280,P＜0.001),and serum HGF(OR=1.189,P＜0.001)were risk factors for poor prognosis in patients,while serum LXA4(OR=0.827,P＜0.001)was a protective factor.The area under the curve of the combined detection of serum HGF and LXA4 for evaluating poor prognosis in patients was 0.912(95％CI:0.862-0.955),which was larger than that of the single detection(Z=4.254,3.819,all P＜0.001).Conclusion The serum HGF level increases and LXA4 level decreases in patients with acute exacerbation of bronchiectasis,which are related to the severity of the disease.Combined detection has high predictive value for poor progno-sis in patients.