Objective To investigate the infection effects of different strains(Prototype,Delta,Beta,and Omicron BA. 1)of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)on transgenic mice K18-hACE2 expressing angiotensinconverting enzyme 2(ACE2)by nasal drip.MethodsMice were challenged with each strain of different gradients of doses by nasal drip,which were monitored for body mass and survival daily for 6 d in Beta group and 14 d in the other three groups. The median lethal dose(LD_(50))was calculated by IBM SPSS Statistics 26 analysis software,and the virulence of different SARS-CoV-2 strains were compared by detection of the viral nucleic acid loads of lung,brain and turbinate tissues and the lesion of lung tissues.ResultsBeta strain showed the strongest virulence and the highest lethality,and the lowest dose(1 CCID_(50))was 100% lethal with a LD_(50)less than 1 CCID_(50);The LD_(50) of Delta,Prototype and Omicron BA.1 strains were 0. 52,0. 60 and 52. 92 CCID50respectively. The copy number of viral nucleic acid in lung tissue of mice infected with different strains elevated with the increase of challenge dose,and the copy number of viral nucleic acid in brain tissue of dead mice reached 10~8～ 10~(11) copies/mL. The lung tissues of mice infected with different strains of different doses showed different degrees of pathological damage.ConclusionThe virulence of different SARS-CoV-2 strains in K18-hACE2 mice from high to low were Beta,Delta,Prototype and Omicron BA.1.

Objective Discussion of diagnosing insulinoma.Methods Retrospective analysis based on 45 cases of insulinoma patients that are collected by General Surgery Department in the First Affiliated Hospital of Zhengzhou University from June 2008 to October 2014.Results Forty-five cases of patients with insulinoma including 41 cases (91.11％) of functional insulinoma and 4 cases (8.89％) of non-functional insulinoma.Apply selective arteriography,preoperative ultrasound,intraoperative ultrasound and CT to diagnosis.Forty-five cases of patients with insulinoma,in which 18 cases with laparoscopic simple tumor resection,6 cases with laparoscopic splenectomy and tail of the pancreas resection;45 cases of insulinoma with laprotomy,in which 8 cases with pancreaticoduodenectomy,12 cases which the tumors were located in the neck,neck-line of the pancreas with local excision of the pancreas and pancreatic tail-jejunal Roux-en-Y anastomosis,one cases of laparotomy found no placeholder.Conclusions Surgery removal is currently the most successful way to eliminate insulinoma.And localization diagnosis can determine the outcome of the surgery.Co-operation of surgery removal and localization diagnosis can be the optimal approach to diagnose certain insulinoma.

Multiple myeloma (MM) is a malignant plasma cell disease, accounting for about 1% of all malignant tumors, is still uncurable, minimal residual disease (MRD) is the reason, therefore, removal of minimal residual disease maybe possible to cure the disease. In a variety of treatment methods, immune gene therapy for multiple myeloma is a hot research topic in recent years, has achieved good results in vitro and in vivo experiments, in this review immune genes therapy in multiple myeloma research would be discussed.

Objective: To study the determinants that affect patient satisfaction to rural doctors. Methods:Based on survey data of Liupanshui City, Guizhou Province, structural equation modeling analysis was adopted, and the study was mainly from the following four aspects:the image of rural doctors, service quality, quality of diagnosis and treatment, and harmonious doctor-patient relationships. Results: The study found that the quality of diagnosis and treatment had the greatest direct impact on rural patient satisfaction, followed by service quality, the image of ru-ral doctors and harmonious doctor-patient relationships;rural patient satisfaction has a significant impact on rural pa-tient loyalty. Conclusion:Rural patient satisfaction and loyalty to rural doctors is mainly based on kinship and geopo-litical relations;given the state of medical technology, the medical environment, medical equipment, service aware-ness and other restrictions, rural doctors cannot fulfill the “gatekeeper” role, and consequently, the primary health-care system has been severely affected.

Objective To make the detection results of the different automated hematology analyzers in laboratory to be reliable and comparable.Methods With the Beckman Coulter LH750 after calibration as the reference instrument,the fresh whole blood was extracted from the patient and divided into 3 equal parts after mixing evenly.The first part was determined the target value in the LH750 instrument;the second part was used to calibrate the HMX and ABX PENTRA 60 instruments and the third part served as a calibration validation.After calibration,the fresh whole blood of patient was performed the detection for conducting the accuracy evaluation.Results After calibration,the detection results of RBC,HGB,WBC,HCT,MCV and PLT by each instrument were largely improved and the error of the results was less than 1/3 of CLIA′88 requirements.Conclusion Adopting fresh whole blood for calibrating the hematology analyzer is feasible.

Structural heart diseases refer to anatomic heart or great vessels abnormalities by congential or acquired factors, including congenital heart disease, acquired heart valve disease, cardiomyopathy. In recent years, interventional therapy in structural heart diseases has gradually matured and been widely applied in clinical practice. Due to the fragility of heart valves and valve related organizations, or the congenital dysplasia of valves, the complex interventional therapeutic procedures can cause valve-related complications. In this paper, the causes, prevention and treatment of valve-related complications induced by interventional therapy in structural heart diseases are introduced.

Objective To analyze the fracture characteristics, operative indicators, complications and treatment results of intertrochanteric fractures of femur in over 80 years old cases. Methods A total of 87 cases (90 hips) of intertrochanteric fractures with mean age over 80 years treated with operative methods from October 1996 to October 2004 were reviewed upon fracture types, preoperative primary diseases, operative methods and postoperative complications. Results The average age was 83.5 years. Of all, 74 cases had different physical diseases included cardiovascular, cerebrovascular, respiratory, digestive system and others (average 2.4 diseases per person). Treatment methods included DHS and intramedullary interlocking nail such as Gamma nail, PFN and reconstructive nails. A follow up for six months in 63 cases showed that excellence rate of functional evaluation was 84%(53/63). Conclusions The full evaluation and treatment of preoperative diseases are the prerequisite for the intertrochanteric fractures in the elderly, for the intertrochanteric fractures in the elderly have high incidence and many preoperative diseases and severe complications.

Objective To explore the association of single nucleotide polymorphism-SNP44 of Calpain 10 gene with genetic susceptibility to type 2 diabetes in Kunming.Methods The polymorphism of site UCSNP44(T/C) in Calpain 10 gene was detected by Polymerase chain reaction and Allele specific amplification(PCR-ASA)in 131 type 2 diabetic patients and 131 non-diabetic controls who were selected using case-control study in the Kunming urban communities.Results The frequency of"C"allele and"TC"gene of SNP44 in type 2 diabetic patients was significantly higher than that in the controls.Conclusion The study suggested that the polymorphism-SNP44 of Calpain10 gene may be associated with genetic susceptibility to type 2 diabetes in Kunming population.

Objective To investigate the value of early hematocrit (Hct) level in predicting early neurological deterioration (END) in patients with acute ischemic stroke. Methods The patients with acute ischemic stroke within 24 h of onset were enrolled prospectively. They were divided into low Hct, normal Hct, and high Hct according to the quantile of the measured Hct. END was defined as an increase of ≥2 of the National Institute of Health Stroke Scale (NIHSS) score or ≥1 of the motor item score within 5 d after admission compared with the baseline. The vascular risk factors, clinical features, baseline NIHSS score, infarct size, and laboratory test variables were compared between the END group and the non -END group. Multivariate logistic regression analysis was used to identify the independent risk factors for END. Results A total of 216 patients with acute ischemic stroke were enrolled, including 128 males (59.26%). Their mean age was 67.40 ±14.12 years. Sixty-two patients (28.70%) experienced END. The normal ranges of Hct in male and female were 40.12%-46.35% and 38.32%-44.17%, respectively. Univariate analysis indicated that there were significantly differences in baseline NIHSS score ( P =0.001), fasting glucose (P =0.030), C reactive protein (CRP) (P =0.041), and the proportions of different Hct levels between the END group and the non-END group (P =0.023). The END incidences in patients with high -level Hct (40.0%) and low –level Hct (35.2%) were significantly higher than that in the normal Hct patients (20 .4%), but there was no significant difference between the high-level and low -level Hct patients ( P = 0.690). Multivariate logistic regression analysis showed that theigh-level Hct (odds ratio 2.460, 95% confidence interval 1.146-5.283; P =0.021) and the baseline NIHSS score (odds ratio 1.070, 95% confidence interval 1.014-1.129; P = 0.013) were the independent risk factors for END. Conclusion The elevated Hct in patients with acute ischemic stroke are susceptible to END.

Sclerosing pneumocytoma is now classified into adenomas of the lung tumor belonging to benign tumors . Multiple sclerosing pneumocytoma is rare .A fifty-nine years old female patient underwent minimally invasive small incision , muscle-and rib-sparing thoracotomy ( miMRST) in August 2012.A lobectomy was made for a 5-cm tumor at the right lower lobe of the lung and a wedge resection was made for another 0.7-cm tumor at the right middle lobe of the lung .Post-operative pathological diagnosis was multiple sclerosing pneumocytoma .No recurrence or metastasis was found after four years ' follow-up.