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.

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.

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.

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 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.

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.

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.

Objective To study the relation between the levels of protein C(PC),protein S(PS),antithrombin Ⅲ(AT-Ⅲ)with cerebral infarction.Methods 126 patients with cerebral infarction were divided into the groups according to the age,onset time and infarction area and contemporaneous 30 individuals with healthy physical examination were selected as the control group.The levels of PC,PS and AT-Ⅲ were detected.The relation between the change of these indicator levels with the age,onset time and infarction area was analyzed Results The levels of AT-Ⅲ,PC and PS in the acute stage youth group were lower than those in the acute stage middle age and elderly group with statistical differences between them (P <0.05).The level of the AT-Ⅲ,PC and PS in the acute stage group were lower than those in the recovery stage group and the control group,difference had statistical significance(P <0.05).The levels of AT-Ⅲ and PS in the recovery stage group were lower than those in the control group with statistical difference (P <0.05),but the level of PC had no statistical difference between the recovery stage group and the control group.The further study found that the level of AT-Ⅲ,PC and PS in the small infarction group,middle infarction group and large infarction group showed the gradually decreasing trend,the differences had statistical significance (P <0.05).Conclusion The decrease of AT-Ⅲ, PC and PS levels is the importan factor of cerebral infarction occurrence and is closely correlated with cerebral infarction ocurrence especially in the patients less than 45 years old.Observing the change of PC,PS and AT-Ⅲ levels has the important significance for judging the cerebral infarction progression.

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.

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.