Objective:To explore the value of panoramic teaching in clinical practice teaching of department of respiratory medicine.Methods:A total of 35 clinical interns who had a 3-week rotation in the department of respiratory medicine from October 2019 to June 2020 were selected, and they were divided into a control group ( n=17) and a study group ( n=18) according to the order of admission. The control group used traditional teaching, and the research group used panoramic teaching. After the teaching, the teaching effect was evaluated through theoretical knowledge assessment, practical assessment and questionnaire survey. SPSS 19.0 was used for t test. Results:There was no statistically significant difference between the two groups of interns in theoretical assessment [(89.62±4.05) points vs. (90.84±4.12) points, t=-0.891, P=0.379]. The results of practice assessment (case analysis, physical examination of the department, medical history inquiry and skills manipulation) of the study group were significantly higher than those of the control group ( P<0.05). The interns in study group were better than those in control group in such aspects as learning interest, self-learning ability, self-study ability, doctor-patient communication language expression ability, literature review ability, clinical thinking ability, comprehensive analysis ability, knowledge development ability, system diagnosis ability, teamwork ability and teaching satisfaction ( P<0.05). Conclusion:Panoramic teaching can effectively improve the ability of interns to master the clinical diagnosis and treatment of respiratory medicine, improve the teaching effect, and improve the learning ability and clinical competence of interns in the future.

Objective:To investigate the characteristics of fragility fractures of pelvis(FFP) in the elderly and compare the clinical efficacy between conservative treatment and minimally invasive surgery.Methods:A retrospective study was conducted in the 56 elderly FFP patients who had been treated at Department of Orthopaedics, The General Hospital of Chinese People＇s Liberation Army from January 2017 to January 2019. They were 16 males and 40 females, with an age of 73.4 years (from 65 to 93 years). By the American Society of Anesthesiologists (ASA) classification, there were 12 cases of grade Ⅰ, 16 cases of grade Ⅱ, 20 cases of grade Ⅲ, and 8 cases of grade Ⅳ; by the FFP classification, there were 6 cases of type Ⅰ, 10 cases of type Ⅱ, 36 cases of type Ⅲ, and 4 cases of type Ⅳ. The morphological characteristics and injury mechanisms of FFP were analyzed. According to the treatment methods, the patients were divided into a conservative treatment group of 32 cases and a minimally invasive surgery group of 24 cases. The 2 groups were compared in terms of complication incidence, mortality and the Koval attenuation rate of walking ability after one-year follow-up.Results:There were mostly the fractures of pubic branches on both sides of the pubic symphysis and compression fractures of the sacral wing caused by lateral crush injury. The 2 groups were comparable due to no significant differences in the preoperative general data between them other than FFP classification ( P>0.05). By one year after treatment, the conservative treatment group had a complication incidence of 34.4% (11/32), a mortality of 9.4% (3/32) and a Koval attenuation rate of walking ability of 13.8% (4/29) while the minimally invasive surgery group had a complication incidence of 20.8% (5/24), a mortality of 4.2% (1/24) and a Koval attenuation rate of walking ability of 8.7%(2/23), showing no significant difference between the 2 groups ( P>0.05). Conclusions:The injury mechanism of geriatric FFP is mostly lateral compression injury. The fracture sites are mostly located on both sides of the pubic symphysis, pubic branches and the sacral wing of anterior and posterior rings simultaneously. Although there may be no significant difference in complication incidence, mortality or Koval attenuation rate of walking ability between conservative treatment and minimally invasive surgery after one year, the minimally invasive surgery deals with more unstable fracture types.

Objective To investigate the influencing factors of cognitive dysfunction in elderly patients with hypertension.Methods From October 2015 to October 2016,one hundred and fifty-one elderly hypertensive patients treated in the Affiliated Hospital of North China University of Science and Technologywere selected as the observation group,and 151 healthy subjects in the same period were enrolled in the control group.The blood pressure measurement and cognitive function evaluation were given to analyze the influencing factors of elderly hypertensive patients with cognitive dysfunction.Results Diastolic pressure ((98.5 ±4.2) mmHg),systolic pressure ((157.6 ± 8.9) mmHg),pulse pressure ((59.1 ± 4.3) mmHg) and cognitive impairment rate(27.2％) in observation group were higher than those in the control group((82.7±3.6 mmHg,(122.4± 6.8) mmHg,(39.7 ± 2.5) mmHg,0.0％),the differences were statistically significant (t =4.951,5.868,8.128,P＜ 0.05).The language fluency ((2.5 ± 0.2) points),memory ability ((2.7 ± 0.4) points),visual spatial executive ability ((2.9±0.2) points),naming ability ((2.6±0.1 points),abstract generalization ability ((1.7±0.2) points),orientation ability ((5.0 ± 0.4) points),attention and calculation ability ((5.1 ±0.3) points),total score ((22.5±0.8) points)in observation group were lower than those in the control group ((2.8±0.1) points,(4.8 ± 0.2) points,(4.7 ± 0.3) points,(2.8 ± 0.2) points,(1.9 ± 0.1) points,(5.7 ±0.1) points,(5.7±0.2) points,(28.4±0.6) points) (t=4.202,10.778,9.206,3.769,4.173,4.405,4.278,5.727,P＜0.05).Diastolic pressure ((103.7 ± 2.5)mmHg),systolic pressure ((164.8 ±4.1) mmHg),pulse pressure((64.5± 1.6) mmHg)in patients with cognitive dysfunction were higher than those in patients without cognitive dysfunction ((92.6±2.8) mmHg,(145.7±3.9) mmHg,(46.3± 1.5) mmHg) (t =4.195,4.310,6.913,P＜0.05).Age distribution (≤65 years old in 9 cases,＞65 years old in 32 cases),BMI index distribution (≤24 kg/m2 in 11 cases,＞24 kg/m2 in 30 cases) in patients without cognitive dysfunction were better than those in patients with cognitive dysfunction ((≤ 65 yeas old in 64 cases,＞ 65 years old in 46 cases),(≤ 24 kg/m2 in 68 cases,＞ 24 kg/m2 in 42 cases)).The differences were statistically significant (x2 =15.700,14.657,P ＜ 0.05).Multiple linear regression analysis showed that cognitive function in elderly hypertensive patients was related to age,BMI index,diastolic blood pressure and pulse pressure (OR (95％CI):4.265 (2.038 ～ 8.927),3.991 (1.956～8.142),3.294 (1.532 ～ 7.084),3.521 (1.640 ～ 7.561),5 (2.375 ～10.528);P=0.000).Condusion Age,BMI index,diastolic blood pressure,systolic blood pressure,pulse pressure are influencing factors in elderly hypertension patients with cognitive dysfunction.

Objective To evaluate the accuracy of variation of epidural labor analgesia in predicting cesarean section.Methods A total of 1 200 parturients with a single baby who were at full term with a singleton fetus,aged 22-34 yr,weighing 60-85 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,volunteered for epidural labor analgesia for pain relief,were enrolled in the study.Epidural labor analgesia (patient-controlled epidural analgesia) was performed when uterine contraction was regular and cervical dilatation was 2-3 cm.Patient-controlled epidural analgesia solution contained the mixture of 0.1％ ropivacaine and fentanyl 2 μg/ml with a background infusion 9 ml/h,bolus dose 4 ml,lockout interval 15 min.The variation of labor analgesia was defined as the difference between the highest visual analog scale score during labor and the visual analog scale score at 30 min after epidural injection of the initial dose of local anesthetic.The receiver operating characteristic curve was used to evaluate the accuracy of variation of epidural labor analgesia in predicting cesarean section.The optimal cut-off value was determined according to the maximum Youden index.Results The area under the receiver operating characteristic curve of variation of epidural labor analgesia in predicting cesarean section was 0.795,and the maximum Youden index was 53.6％,the sensitivity 87.5％ and the specificity 66.1％ when the cut-off value was 3.Conclusion Variation of epidural labor analgesia produces better accuracy in predicting cesarean section.

Objective To investigate the relationship between mild cognitive impairment and quality of life in hemodialysis patients with diabetic nephropathy.Methods One hundred and twenty-five hemodialysis patients with diabetic nephropathy were selected in Affiliated Hospital of North China University of Science and Technology from December 2014 to December 2016,and were divided into two groups according to mild cognitive impairment,including 73 patients without mild cognitive impairment as control group,and 52 patients with mild cognitive impairment as observation group.Patients received Montreal cognitive assessment scale and kidney disease quality of life scale.Patients received clinical index detection.Results Montreal cognitive assessment scale(visual space and execution(3.0±0.7) points,naming(2.4±0.3) points,attention(4.3±0.7) points,language(2.1±0.4) points,abstraction(1.1±0.2) points,delayed recall(1.6±0.3) points,orientation(5.4±0.5) points) score,kidney disease quality of life scale(physical(70.3±3.5) points,physical constraints due to work and life(14.6±2.8) points,pain(56.4±7.1) points,general health(36.2±3.4) points,emotional status(51.3±2.6) points,social function(52.7±3.4) points,mental status(43.2±3.6) points,emotional constraints due to work and life(41.3±2.8) points,symptoms(73.6±2.1) points,work status(20.3±1.6) points,cognitive function(72.7±1.8) points,nephropathy effect(49.1±3.2) points,sexual function(53.2±4.0) points,burden of nephropathy(21.3±2.6) points,sleep quality(70.1±1.5) points,social quality(43.3±1.9) points,social support(71.2±2.3) points) score in observation group were lower than control group((4.4±0.8) points,(3.0±0.0) points,(5.4±0.5) points,(2.7±0.3) points,(1.8±0.4) points,(3.4±0.6) points,(6.0±0.0) points),((78.6±4.1) points,(25.7±3.6) points,(69.8±4.2) points,(41.0±2.7) points,(58.5±3.0) points,(61.2±3.8) points,(53.4±2.8) points,(46.5±2.4) points,(82.9±3.2) points,(24.2±2.7) points,(81.6±2.3) points,(65.3±4.0) points,(62.8±3.9) points,(35.7±2.8) points,(79.3±2.0) points,(59.7±2.4) points,(82.4±2.6) points)(t=7.667,5.502,5.558,5.857,9.364,14.250,4.112,4.038,10.603,5.321,4.326,4.403,4.613,5.361,4.262,4.315,4.923,4.224,6.265,4.804,6.712,4.316,6.787,4.573,all P<0.05).Conclusion Hemodialysis patients with diabetic nephropathy has mild cognitive impairment,while quality of life is low.

Objective To compare dexmedetomidine administered via different routes for epidural anesthesia during second cesarean section.Methods Sixty parturients who were at full term with a singleton fetus,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 22-38 yr,weighing 58-84 kg,undergoing a second caesarean section under epidural anesthesia,were divided into 3 groups (n=20 each) using a random number table:Ⅳ infusion of dexmedetomidine conbined with epidural injection of ropivacaine group (VDER group),epidural injection of a mixture of ropivacaine and dexmedetomidine group (ERD group) and epidural injection of ropivacaine group (ER group).The epidural puncture was performed at L2,3.After identification of the epidural space and a negative aspiration test for blood or cerebrospinal fluid,the mixture of 0.75％ ropivacaine 15 ml and 0.9％ normal saline 2 ml was injected epidurally,and dexmedetomidine 1 μg/kg was intravenously infused for 10 min at the same time in VDER group;the mixture of 0.75％ ropivacaine 15 ml and 1 μg/kg dexmedetomidine 2 ml was injected epidurally in ERD group;the mixture of 0.75％ ropivacaine 15 ml and 0.9％ normal saline 2 ml was injected epidurally in ER group.The onset time of epidural block,maximum level ofepidural block,time to reach the maximum epidural block and time of sensory block were recorded.Ramsay sedation scores were assessed at 30 miu after the end of epidural administration,and intraoperative traction reaction was also assessed.The development of hypotension,bradycardia,respiratory depressim and shivering was observed.The number of patients in whom remifentanil was used before delivery and Apgar scores at 1 and 5 min after birth were recorded.Results Compared with VDER group and ER group,the onset time and time to reach the maximum epidural block were significantly shortened,and the time of sensory block was prolonged in ERD group (P＜0.05).Compared with ER group,the rate of satisfactory sedation was significantly increased,the number of patients in whom remifentanil was used before delivery was decreased,the degree of intraoperative traction reaclion was mitigated,and the incidence of respiratory depression and shivering was decreased (P＜0.05),and no significant change was found in Apgar scores at 1 and 5 min after birth in VDER and ERD groups (P＞0.05).Conclusion Both Ⅳ and epidural dexmedetomidine can enhance the efficacy of epidural anesthesia during second cesarean section,producing no adverse effects on neonates;epidural injection of a mixture of ropivacaine and dexmedetomidine provides faster onset and prolonged time of sensory block,which is helpful for postoperative analgesia.

Background and objective The aim of this study is to investigate the clinical characteristics of patients with primary bronchopulmonary carcinoma complicated with chronic obstructive pulmonary disease (COPD), and to opti-mize the early diagnoses in the coexistence of COPD and primary bronchopulmonary carcinoma.Methods The clinical data of 118 patients with COPD complicated with primary bronchopulmonary carcinoma were analyzed retrospectively, including age, sex, smoking history, smoking index, clinical symptoms and signs, pathological type, staging, metastasis site and lung func-tion index. 120 patients with simple COPD were selected as control.Results The smoking rate (55.1%) and smoking index ≥400 branch /year (90.8%) of the patients with COPD complicated with primary bronchopulmonary carcinoma were higher than the simple COPD group (20.8%, 48.0%). The difference between the two groups was statistically significant (P<0.01). There were no significant differences in the incidence of common symptoms such as cough, sputum, fever, fatigue and dyspnea in COPD complicated with primary bronchopulmonary carcinoma patients with simple COPD group (P>0.05), while the in-cidence of hemoptysis, weight loss, chest pain, hoarseness, pleural effusion and atelectasis were significantly higher than those in simple COPD group (P<0.01). When the patients were first diagnosed as COPD with primary bronchopulmonary carcino-ma, 63.6% of the group were advanced or located late, and the distant metastases are common for pleural metastasis and bone metastases. There was no significant difference in forced expiratory volume in one second/forced vital capacity (FEV1/FVC),FEV1% pre, total lung capacity (TLC) and residual volume (RV)/TLC between the two groups (P>0.05), but the diffusing capacity of carbon monoxide (DLCO) of COPD patients complicated with primary bronchopulmonary carcinoma was lower than that of simple COPD patients (P<0.05) . In the COPD patients with primary bronchopulmonary carcinoma, squamous cell carcinoma was the most common pathological type (51.7%). Male patients were mainly squamous cell carcinoma (60.7%), while female patients with adenocarcinoma (69.0%).Conclusion COPD combined with primary bronchopulmonary carci-noma occurs in male smokers more. There is higher incidence of squamous cell carcinoma. When they are first diagnosed, most of them are advanced or located late, due to no specific clinical symptoms at the early stages. Periodic chest CT examination for COPD patients can help early diagnoses of primary bronchopulmonary carcinoma.

Objective To observe the clinical efficacy of the combination of modification ofChaihu Jia Longgu MuliDecoction with psychological intervention in the treatment of post tumor depression.MethodsTotally 122 cases of post tumor depression were divided into treatment group and control group by simple numeration table random method, with 61 cases in each group. The treatment group was given modification ofChaihu Jia Longgu Muli Decoction orally, at the same time psychological intervention was given. The control group was given escitalopram oxalate tablets for 6 weeks. HAMD scale scores of the two groups were observed before and after treatment to evaluate the clinical efficacy. Changes in life quality of two groups were scored with SF-36 scale. The adverse reactions were also observed.ResultsAfter treatment, the HAMD score of treatment group was lower than control group (P<0.05). The total effective rate was 88.52% (54/61) in the treatment group and 72.13% (44/61) in the control group, with statistical significance (P<0.05). The scores of life quality of treatment group were higher than control group (P<0.05), and the incidence of adverse reactions was lower than control group (P<0.05).Conclusion Combination of modification ofChaihu Jia Longgu MuliDecoction with psychological intervention in the treatment of post tumor depression can significantly improve the depressive state and life quality of the patients with post tumor depression, which is better than the control group, without significant adverse reactions.

Objective To investigate the placental transfer and neonatal effects of dexmedetomidine during the cesarean section under general anesthesia.Methods Thirty-eight nulliparous parturients,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 22-37 yr,weighing 56-82 kg,who were at full term with a singleton fetus,scheduled for elective caesarean section under general anesthesia,were randomly divided into 2 groups (n=19 each) using a random number table:dexmedetomidine group (group D) and normal saline group (group N).In group D,dexmedetomidine was infused in a loading dose of 0.6 μg/kg starting from 10 min before induction of anesthesia,followed by an infusion of 0.4 μg · kg-1 · h-1 until peritoneal closure.Group N received the equal volume of normal saline.Blood samples were collected from the maternal artery (MA),umbilical vein (UV),and umbilical artery (UA) for blood gas analysis and for determination of plasma dexmedetomidine concentrations (CMA,CUV and CUA) by high-performance liquid chromatography-mass spectrometry,and CUV/CMA and CUA/CUV were calculated.Apgar scores were recorded at 1 and 5 min after delivery,and the occurrence of respiratory depression was also recorded.The I-D interval (the time from administration of anesthetics to delivery) and U-D interval (the time from incision of the uterus to delivery) were recorded.Results There were no significant differences in the blood gas analysis parameters in blood samples collected from the MA,UV and UA,I-D interval,U-D interval,and Apgar scores between the two groups (P＞0.05).No neonatal respiratory depression was found in both groups.In group D,CMA,CUV and CUA were 471±119,359±88 and (321±78) ng/ml,respectively,CUV/CMA was 0.76±0.06,and CUA/CUV was 0.89±0.03.Conclusion Although the metabolism of dexmedetomidine is little after easy placental transfer,dexmedetomidine has no adverse effects on the newborn during the cesarean section under general anesthesia.