Objective To compare the different front plastic angle with reinforced plastic endotracheal tube guidance by McGrath -5 video laryngoscope for orotracheal intubation in obesity.Methods 1 20 cases with obesity undergoing general anesthesia,ASA gradeⅠ -Ⅲ who planned intubation guidance by McGrath -5 video laryngo-scope,were randomly divided into three group according to different front plastic angle for endotracheal tube:group A (catheter 60°),group B(catheter 75°),C group(catheter 90°),40 cases in each group.General information and air-way evaluation indexes such as Mallampati classification,the degree of open mouth,neck circumference,thyromental distance,atlanto -occipital joint stretch degree preoperatively were recorded.C /L classification with laryngoscopic exposure,the successful rate of first intubation,time of first intubation,cases of second intubation,the incidence of blood stained catheter and postoperative sore throat and hoarseness were recorded also.Results There were no signif-icant differences of patients with general information and airway evaluating indexes such as Mallampati classification, the degree of open mouth,neck circumference,thyromental distance,atlanto -occipital joint stretch degree among three groups(P >0.05).The successful rate of catheter alignment glottal was 97.5% in group B,which was signifi-cantly higher than that of group A(80.0%)and group C(85.0%)(χ2 =8.36,P <0.05).The time of first intuba-tion was 21 (1 0 -65)s in group B,which was significantly shorter than that in group A[30(1 4 -78)s,Z =3.87,P <0.05]and group C[32(9 -80)s,Z =4.32,P <0.05].All patients in three groups had successful intubation firstly or secondly.The incidence rate of blood stained catheter in group B(2.5%)was significantly lower than that in group A(1 0%)and group C(1 5%,P <0.05 ),but there was no significant difference in postoperative sore throat and hoarseness among three groups(P >0.05).Conclusion McGrath -5 video laryngoscope which guided endotracheal tube with front plastic angle at 75°degree has highest success rate of intubation,shortest intubation time,least compli-cation and is suitable for the application of tracheal intubation in obese patients.

Livin is a new and important member of the inhibitor of apoptosis protein(IAPs)family.Livin is high expressed in most human tumor cells, involved in apoptosis inhibition and closely related with tumor development and progression.Studies found that through the down-regulation or inhibition of Livin expression and the induction specific antibodies of Livin could inhibi and kill tumor cells, which provided a new method for tumors'diagnosis, cell and gene targeted therapy.

Objective To observe the effect of Naomaitai Capsule on the learning and memory abilities and cerebral lipid-peroxidation in rat with vascular dementia(VD).Methods Two VD models were(established).The first one was produced by occlusion of bilateral common carotid arteries in rats with the(following) steps: ischemia 20 min—reperfusion 10 min—ischemia 20 min.The learning and memory abilities were tested by Y type maze.Meanwhile,malondiadehyde(MDA) content and superoxide dismutase(SOD) activity in brain tissue of ischemia-reperfusion rats were measured.The second model was formed by injecting thrombin NS solution into internal carotid artery.The learning and memory abilities were studied by Y type Maze.The content of Evans blue in brain tissue was measured.Results In the model caused by cerebral ischemia-reperfusion,Naomaitai Capsule significantly improved the learning and memory abilities((P

objective To explore a new method of repairing skin defects complicated with fracture and tendon rupture at the middle and distal sections of the second to fifth fingers. Methods The reversed dorsal metacarpal island flap was designed to be pedicled on the digital proper artery-common digital artery-fingerweb artery-dorsal metacarpal artery-cutaneous branch of dorsal metacarpal artery.In repairing digital palmar skin defects,after the flap was dissected,the proximal incision was extended along the direction of dorsal metacarpal nerve to harvest an enough length of the nerve so that the dorsal metacrppal nerve can be anastomosed with the digital proper nerve to restore the sensation of finger pulp.From the June 2003 to March 2009,the flap was used to repair 26 fingers in 24 patients with middle and distal digital skin defects complicated with fracture and tendon rupture.They were 17 men and 7 women,aged from 16 to 63 years (average,37 years).There were 15 cases of palmar skin defect and 9 cases of dorsal skin defect.In the 2 cases of combined tendon defects,a section of the extensor tendon of index(or little) finger was dissected together with the flap to repair the tendon rupture. Results The areas of the flap ranged from 3.1 cm ×1.6 cm to 6.0 cm × 4.0 cm.The flaps survived in all 24 cases without any vascular crisis.Twenty-two patients obtained an average follow-up of 14 months (from 4 to 32 months) but 2 were lost to the follow-up.The flaps were fine in texture,colour and appearance.The finger pulps appeared full and recovered sensations of pain and temperature.The average two-point discrimination was 7.5 mm (from 5 to 9 mm).Sensory function evaluation revealed an outcome of S3 + ～ S4.Tendon adhesion occurred in 4 cases which recovered digital function following secondary lysis 3 to 6 months postoperation. Conclusion Application of the reversed dorsal metacarpal island flap pedicled on the digital proper artery is a good way to repair skin defects complicated with fracture and tendon rupture at the middle and distal sections of the second to fifth fingers.

Objective To compare the clinical efficacy of double-lumen tube intubation between McGrath-5 video-laryngoscope and McCoy laryngoscope in patients with difficult airway. Methods Sixty patients who were predicted as difficult double-lumen tube intubation were divided into two groups using random number table method:McGrath-5 video-laryngoscope group (group A, n = 30) and McCoy laryngoscope group (group B, n = 30). All patients were intubated by two laryngoscopes correspondingly after conventional induction. The success rate of the first intubation, intubation time, the ratio of right positioning, the number of SpO2 < 90% within intubation time, the number of pressing the cricoid, the incidence of intubation complications and hemodynamic parameters [The changes in systolic pressure and heart rate and BIS were recorded before induction (T0), glottic exposure upon laryngoscope insertion (T1), immediately after intubation (T2), 3 min (T3) after intubation]. Results The number of pressing the cricoid was smaller in group A than in group B (P < 0.05), whereas the intubation time in group A was significantly higher than that in group B (P < 0.05). The systolic pressure and heart rate at T3 were dramatically reduced compared with those measured at T0 in both groups (P < 0.05). The systolic pressure and heart rate at T1 and T2 in group A were considerably lower in group A than those in group B (P < 0.05). Conclusions Compared with the McCoy laryngoscope, double-lumen tube intubation by McGrath-5 video-laryngoscope can less impact on hemodynamics, less intubation complications, intubation time although prolonged but not for influence the patient's oxygen supply, for difficult airway double-lumen tube intubation provides a good choice.

Background: NEDD9 plays an important role in cell migration, chemotaxis, apoptosis, and cell cycle. NEDD9 siRNA can effectively reduce the gene expression, promote apoptosis and block tumor cell migration and invasion at different levels. Aims: To investigate the expression of NEDD9 in colon cancer tissue, and the effect of NEDD9 siRNA on proliferation, apoptosis, migration and invasion of colon cancer Caco-2 cells. Methods: Colon cancer tissue and corresponding paracancerous tissue from Jan. 2017 to Jan. 2018 at Yancheng District People's Hospital of Luohe were collected. Colon cancer Caco-2 cells were conventionally cultured, and were transfected by LipofectamineTM 2000. Caco-2 cells were divided into control group, negative control group and siRNA interference group. The mRNA expression of NEDD9 in colon cancer tissue and Caco-2 cells was detected by qRT-PCR. The proliferation of Caco-2 cells was detected by CCK-8 method. The apoptosis of Caco-2 cells was detected by flow cytometry. Caco-2 cell migration and invasion were detected by Transwell assay. The protein expressions of NEDD9, MMP-9, Bcl-2, Bax, TIMP1 were determined by Western blotting. Results: The mRNA expression of NEDD9 in colon cancer tissue was significantly higher than that in paracancerous tissue (P<0.05). Compared with control group, the mRNA expression of NEDD9 in the siRNA interference group was significantly decreased (P<0.05), cell proliferation, migration and invasion were significantly inhibited (P<0.05), cell apoptosis was significantly increased (P<0.05), and the protein expressions of NEDD9, MMP-9 and Bcl-2 were significantly decreased (P<0.05), the protein expressions of Bax and TIMP1 were significantly increased (P<0.05). Conclusions: NEDD9 gene can regulate the proliferation, apoptosis, migration and invasion of colon cancer Caco-2 cells through apoptosis-related genes Bcl-2 and Bax and invasion-related genes MMP-9 and TIMP1.

Objective MRI manifestations of infiltrative renal pelvis carcinoma were analyzed and evaluated,to improve its diagnostic accuracy. Methods MRI features of 21 cases of infiltrative renal pelvis carcinoma confirmed pathologically were analyzed retrospectively.All patients underwent plain MRI scan and DWI examination,3 cases underwent PWI examination.Results The center of lesions for all cases were located in the renal collection system,with no change of the renal contour.Most lesions were presented as low signal intensity on T1 WI and slightly low signal intensity on T2 WI,and heterogeneous signal intensity were showed on T1 WI and T2 WI in 5 cases.All lesions were presented as high signal intensity on DWI.After contrast enhancement,mild and moderate enhanced lesions were demonstrated in 3 cases.Renal arteries were wrapped by renal pelvis carcinoma on renal AMRA in 3 cases.4 patients were accompanied with venous tumor thrombus and 1 1 patients with retroperitoneal lymph node metastasis.Adrenal gland metastases were showed in 3 cases.1 case was accompanied with ureter urothelial carcinoma,and 2 cases with bladder carcinomas.Conclusion MRI has a multi-parameter imaging capability and high resolution of soft tissue,and can clearly show the boundary of lesions and surroundings.MRI plays an important role in the diagnosis and differential diagnosis of infiltrative renal pelvis carcinoma.

Objective To explore the utility of ADC histogram analysisin differentiation of clear cell renal cell carcinoma(ccRCC)and non-clear cell renal cell carcinoma(non-ccRCC)with r-Fov DWI. Methods Sixty-six renal tumors(46 patients with 47 ccRCCs and 18 patients with 19 non-ccRCCs)in 64 patients, who underwent preoperative routine renal MRI sequences and r-FOV DWI, were retrospectively evaluated. The whole-lesion ADC values derived from histogram anlysis(including ADC mean, ADC median, ADC_5th, ADC_25th, ADC_75th, ADC_95th, skew and kurtosis)were measured for each patient. All parameters between ccRCC and non-ccRCC were compared by using the Student's t test or Mann-Whitney U test. ROC analysis was used to assess the diagnostic performance of ADC histogram in distinguishing the two groups. Results The postive skewness of ADC histograms were mostly seen in the non-ccRCC group, while the negtative skewness were present in the majority of ccRCCs. The skewness was significantly higher in non-ccRCCs than those of ccRCCs(P<0.05). Mean ADC, median ADC, 5th percentile ADC, 25th percentile ADC, 75th percentile ADC and 95th percentile ADC(all P<0.05)were significantly lower in non-ccRCC . There was no significant difference of Kurtosis between two groups(P>0.05). 75th percentile ADC achieved the highest AUC(0.987)in differentiating ccRCC and non-ccRCC, whena cutoff value was 1.81× 10-3 mm2/s. The sensitivity and specificity were 100.0％and 94.7％. Conclusion ADC histograms of r-FOV DWI may be helpful to differentiate ccRCC from non-ccRCC, and the diagnostic accuracy of 75th percentile ADC is highest.

Objective To study etiology screening role of transrectal ultrasonography in male obstructive azoospermia infertility.Methods The clinical data of 328 cases who suspected of being obstructed sperm disease were retrospectively analyzed.TRUS detection was conducted,at the same time,the sperm amount,sperm and semen pH,pure berries quantitative,neutral sugar alpha glycosidase enzymes quantitative,elastic hard protease were tested.Results In 328 cases with male obstructed no sperm,by TRUS detection results,216 cases (65.8％) could find the causes,ejaculatory duct expansion,seminal vesicle gland lesions,prostate midline cyst were the top three causes respectively;112 patients(34.2％) had no obvious abnormal ultrasonic testing.Sperm was not seen in semen of obstructive azoospermia patients and semen pH ＜ 7,pure berries sugar quantitative and quantitative value neutral alpha glycosidase enzymes were very low,hard elastic protease was low.Conclusion The main causes of obstructive azoospermia were ejaculatory duct expansion,seminal vesicle gland lesions,prostate midline cyst,sperm TRUS detection used for diagnosis of high sensitivity,and easy to operate,noninvasive,and combined with seminal plasma biochemical examination,the diagnostic effect is much better.

ObjectiveTo investigate the clinical significance of quantitative detection of K-ras codon 12 and 13 mutations in the tissues of pancreatic cancer and related pancreatic diseaaes. Methods One hundred and thirty samples from surgically removed pancreatic tissue with a conclusive pathological diagnosis (105 cases of pancreatic ductal adenocarcinoma,8 cases of pancreatic adenosquamous carcinoma of the pancreas,2 cases of pancreatic mucinous adenocarcinoma,3 cases of pancreatic endocrine carcinoma,6 cases of duodenal and papillary adenocarcinoma and 6 cases of benign pancreatic diseases ) were collected.Quantitative detection of K-ras codon 12 and 13 mutations was performed by the method of peptide nucleic acidmediated PCR clamping with two different fluorescence labeled probes.Mutation number ＞ 100 copies was used as the criteria to calculate the positive mutation rate.ResultsThe median and quartile of K-ras codon 12mutations of pancreatic ductal adenocarcinoma,adenosquamous carcinoma of the pancreas,pancreatic mucinous adenocarcinoma,pancreatic endocrine carcinoma,duodenal and papillary adenocarcinoma and benign pancreatic diseases were 4062 (495,10800),238 (45,8420),15 (9,21),3 (3,16),2283 (73,5037)and 21(8,56),and the positive mutation rates were 84.8％ (89/105),50.0％ (4/8),0,0,66.7％ (4/6)and 16.7％ (1/6).The quantity of K-ras codon 12 mutation in pancreatic ductal adenocarcinoma was not statistically different from those of adenosquamous carcinoma,duodenal and papillary adenocarcinoma,but it was significantly higher than those in pancreatic mucinous adenocarcinoma,pancreatic endocrine carcinoma,and benign pancreatic diseases (P ＜0.05).The area under ROC of K-ras codon 12 mutation in pancreatic ductal adenocarcinoma was 0.727.The sensitivity and specificity of the K-ras codon 12 mutation for the diagnosis of pancreatic ductal adenocarcinoma were 84.8％,64.0％,respectively.The quantity of K-ras codon 12 was associated with survival of patients with pancreatic ductal adenocarcinoma.The quantity of K-ras codon 13 mutations and the positive mutation rates in pancreatic ductal adenocarcinoma was not statistically different from other pancreatic diseases.ConclusionsThe quantity of K-ras codon 12 mutation has good differential diagnostic and prognostic prediction value for pancreatic ductal adenocarcinoma.