Tracheal intubation is an important part in clinical teaching of anesthesiology,it is also the basic skill that each anesthesiologist must master.The distinctive feature of visual technology is intuitive visual,meaning operation process and anatomical structure can be seen directly and clearly.Our department tried to teach tracheal intubation with visual technology.Teachers firstly demonstrated standard incubation with video laryngoscope and explained the related basic theoretical knowledge.Then students practiced the intubation in models until becoming skilled,finally students can practice in real patients.The teaching effect of the modified method was better compared with that of traditional method.

Objective: The aim of our study was to analyse the death cause and related factors of death in hospital of patients after cardiac valve replacement (CVR). Methods: Regression analysis of 34 patients' data was executed. Results: Death rate was 9.9 %, death cause: (1) L.ow cardiac output syndrome is the first complication and death cause (2.6 % ), which was closely related to cardiac function (grade Ⅳ ) before operation, LVEDD＞8.0 cm, LVEF＜0. 40, GR ＞80%, emergency operation, long time of arterial block, etc; (2) Ventricular tachycardia、 ventricular fibrillation is the second cause of death (2. 1%); (3) Respiratory failure (4) Post-operation hemorrhage inducing pericardial tamponade and shock; (5) Postoperation infection of replaced valve and brain complications. Conclusion: The success rate of operation can be increased by selecting patients strictly, improving operation methods, enhancing periopertive monitor.

To obtain the P8 protein of Rice gall dwarf virus (RGDV) with biological activity, its outer coat protein gene S8 was expressed in Spodoptera frugiperda (Sf9) insect cells using the baculovirus expression system. The S8 gene was subcloned into the pFastBacTM1 vector, to produce the recombinant baculovirus transfer vector pFB-S8. After transformation, pFB-S8 was introduced into the competent cells (E. coli DH10Bac) containing a shuttle vector, Bacmid, generating the recombinant bacmid rbpFB-S8. After being infected by recombinant baculovirus rvpFB-S8 at different multiplicities of infection, Sf9 cells were collected at different times and analyzed by SDS-PAGE, Western blotting and immunofluorescence microscopy. The expression level of the P8 protein was highest between 48-72 h after transfection of Sf9 cells. Immunofluorescence microscopy showed that P8 protein of RGDV formed punctate structures in the cytoplasm of Sf9 cells.

Objective:To observe the clinical efficacy of long-time needle retaining at Baihui(GV20)on post-stroke cognitive impairment(PSCI)and its effects on the cognitive ability and living ability of the patients.Methods:A total of 62 PSCI patients were divided into a control group and an observation group by the random number table method,with 31 cases in each group.The control group was treated with routine treatment for stroke in the recovery period plus cognitive training.The observation group received additional acupuncture at Baihui(GV20)with long-time needle retaining based on the same intervention in the control group.The Montreal cognitive assessment(MoCA)was used to evaluate the cognitive ability of patients.The activities of daily living(ADL)scale was used to evaluate the living ability of patients.And the mini-mental state examination(MMSE)scale was used to evaluate the mental state,concentration,language,and abstraction cognition of patients.After 4 weeks,the curative efficacy was observed,and the scores of cognitive level,living ability,mental state and concentration,language,and abstraction understanding ability were compared between the two groups.Results:During the trial,1 patient in each group dropped out due to personal reasons and was unable to continue the treatment.After 4 weeks of treatment,the total effective rate was 83.3%in the observation group and 66.7%in the control group,and the difference between the two groups was statistically significant(P<0.05);the scores of MoCA,ADL,and MMSE,and scores of concentration,language ability,and abstraction understanding ability were all increased,and were statistically different from those before treatment in each group(P<0.05);the scores in the observation group were all higher than those in the control group,and the differences between the groups were statistically significant(P<0.05).Conclusion:On the basis of routine treatment and cognitive training,the clinical efficacy of additional acupuncture at Baihui(GV20)with long-time needle retaining in the treatment of PSCI is better than that of routine treatment plus cognitive training;the treatment can better improve the cognitive function and mental state of patients,and improve their living ability.

Objective To investigate the effects of different high-fat diet feeding time durations on blood glucose (BG), insulin resistance index(HOMA-IR), and urinary albumin excretion rate(UAER)in rats with high fat diet-induced type 2 diabetic nephropathy(DN). Methods Unilateral renal artery ligation, high-fat diet(throughout the ex-periment period),and low dose streptozotocin(STZ)intraperitoneal injection were used to establish a type 2 DN rat mod-el. After the operation,rats in the DN1 and DN2 groups received an intraperitoneal injection of STZ 30 mg/kg after 4 and 8 weeks of high-fat diet feeding,respectively. UAERs of the DN1 and DN2 groups were compared at 4 weeks after the STZ injection and the end of study(EOS). BG,body weight,HOMA-IR,kidney index,and pathological changes of the kidney were observed. Results UAER was increased in both groups at 4 weeks after the STZ injection,but significantly higher in the group DN2 than in the DN1 group(P<0.01). At the end of study(the 12th week),the renal tissues showed patho-logical changes,including glomerular capillary loop hypertrophy,increased mesangial matrix,and decreased capsule space in both groups. Compared with the DN1 group,the body weight was significantly higher(P<0.01),kidney index was sig-nificantly lower(P<0.01),while BG,serum insulin level,HOMA-IR,and UAER were no significantly changed in the DM2 group(P>0.05,respectively). Conclusions The results show that extending the feeding time of high-fat diet can aggravate the kidney damages in diabetic rats,but it can also delay the start of any planned intervention. Therefore,the ex-perimental protocol should be carefully designed based on the study objective.

Objective:To identify the risk factors associated with postoperative adjuvant chemotherapy in patients with stage I gastric cancer and establish nomograms model based on risk factors.Methods:In this retrospective case-control study, 161 cases with stage Ⅰ primary gastric adenocarcinoma were included who underwent gastrectomy at the Department of General Surgery of the First Medical Center of Chinese PLA General Hospital from January to December in 2020, including 129 male cases and 32 females cases, with the average age of (59.90±0.80) years. Among them, 41 cases were treated with postoperative adjuvant chemotherapy (chemotherapy group), while 120 cases who did not receive postoperative adjuvant chemotherapy (no chemotherapy group). Univariate and multivariate Logistic regression analyses were used to identify the risk factors of adjuvant chemotherapy in stage Ⅰ gastric cancer patients and establish the nomograms predictive model. ROC curve and calibration curve were used to evaluate the performance of the model.Results:Multivariate analysis revealed that primary tumor site, tumor size, T stage, N stage lymph-vascular tumor embolus or perineural invasion were the independent risk factors of postoperative adjuvant chemotherapy for stage Ⅰ gastric cancer( P<0.05). The ROC curve indicated that area under the curve (AUC) of the multivariate model was 0.91(95% CI: 0.86-0.97). The calibration curve showed that probability predicted by nomograms was consistent with the actual situation(C-index: 0.91). Conclusions:The tumor located in the proximal stomach, tumor size>2 cm, T 2, N 1, lymph-vascular tumor embolus or perineural invasion maybe be the risk factors for chemotherapy decision in stage Ⅰ gastric cancer patients. The established model has good predictive ability for postoperative chemotherapy of stage Ⅰ gastric cancer patients, which might provide reference for the selection of clinical decisions in this part of patients.

The causes of stroke in young people are diverse, most of which are cardiogenic. However, cerebral embolism caused by cardiac myxoma is rare. Intravenous thrombolysis is given in the time window, and the therapeutic effect depends on the nature of embolus. This case is a young female patient, with acute onset, excluding bleeding on the basis of the symptoms, signs and craniocerebral CT. After diagnosed as acute ischemic stroke, the patient was performed an immediate intravenous thrombolysis, though the curative effect was poor. Excluding contraindications six hours after onset, bridging mechanical thrombectomy was performed, postoperative embolus biopsy indicating myxoma. Atrial myxoma was removed in cardiac surgery two months later, and the pathology indicated atrial myxoma. The patient recovered well during the out-of-hospital follow-up, and no further embolization occurred. Therefore, it is suggested that bridging mechanical thrombectomy may be safe and effective for acute ischemic stroke caused by atrial myxoma when intravenous thrombolysis is ineffective, and myxoma resection should be performed immediately after the disease is stable.

Objective To investigate the effect and mechanism of long-term indwelling needle of Baihui acupoint during acupuncture on improving neurological function in ischemic stroke mice through brain-derived neurotrophic factor(BDNF)/tyrosine receptor kinase B(TrkB)pathway.Methods A total of 48 male C57BL/6J mice were randomly divided into sham group 1,model group 1,long-term indwelling needle group 1 and conventional indwelling needle group,with 12 mice in each group.A mouse model of ischemic stroke was established by thread occlusion in the latter 3 groups.From the first day after modeling,long-term and conventional indwelling needle at Baihui acupoint was given to the mice in the corresponding groups for 14 consecutive days.Anoth-er 40 male C57BL/6J mice were also subjected and randomly divided into sham group 2,model group 2,and long-term indwelling needle groups 2 and 3,with 10 mice in each group.After model-ing in the latter 3 groups,100 pl adeno-associated virus was injected by caudal vein before acu-puncture treatment.Modified neurological severity score(mNSS)and escape latency,residence time in the target quadrant,and times of crossing the original platform in water maze test were used to evaluate neural function.Results Decreased mNSS score,shorter residence time in the target quadrant,less times of crossing the original platform,and reduced expression levels of BDNF and TrkB in the ischemic brain tissue,and higher apoptotic rate and elevated level of cleaved Caspase-3 in the ischemic brain tissue were observed in the model group 1 when compared with the sham group 1(P＜0.05).While long-term and conventional indwelling needle could reverse above indicators,with long-term indwelling needle more significant than the conventional method(P＜0.05).The long-term indwelling needle group 3 obtained lower mNSS score,reduced residence time in the target quadrant,lower times of crossing the original platform and decreased levels of BDNF and TrkB in the ischemic brain tissue(P＜0.05),and higher apoptotic rate and elevated level of cleaved Caspase-3 in the ischemic brain tissue than the long-term indwelling nee-dle group 2[(16.41±2.25)％vs(7.59±1.09)％,1.46±0.16 vs 0.94±0.12,P＜0.05].Conclusion Long-term indwelling needle at Baihui acupoint more significantly improves the neurological func-tion in ischemic stroke mice than ordinary indwelling needle treatment.Its molecular mechanism is due to activating the BDNF/TrkB pathway.

Mitochondrial myopathy is a group of multi-system diseases in which mitochondrial DNA(mtDNA)or nuclear DNA(nDNA)defects lead to structural and functional dysfunction of mitochondria.The clinical manifestations of mitochondrial myopathy are complex and varied,and the testing for mtDNA and nDNA is not widely available,so misdiagnosis or missed diagnosis is common.Chronic progressive external ophthalmoplegia(CPEO)is a common type of mitochondrial myopathy,which is characterized by blepharoptosis.Here we report a 38-year-old female with mitochondrial myopathy presented with chronic numbness and weakness of the limbs,accompanied by blepharoptosis that was recently noticed.Laboratory and head magnetic resonance imaging(MRI)examinations showed no obvious abnormalities.Muscle and nerve biopsies showed characteristic ragged red fibers(RRFs)and large aggregates of denatured mitochondria.Testing for mtDNA and nDNA showed a known mutation c.2857C＞T(p.R953C)and a novel variant c.2391G＞C(p.M797I)in the polymerase gamma(POLG)gene,so the patient was diagnosed as mitochondrial myopathy.Clinicians should pay more attention to long-term unexplained skeletal muscle diseases with recent onset blepharoptosis.Histopathologic examination and genetic testing are of great value in the early diagnosis and therapeutic intervention.

Objective:To investigate the prognosis of patients with initially resectable gastric cancer liver metastasis (GCLM) who were treated by different modalities, and analyze the influencing factors for prognosis of patients.Methods:The retrospective cohort study was conducted. The clinicopathological data of 327 patients with initially resectable GCLM who were included in the database of a nationwide multicenter retrospective cohort study on GCLM based on real-world data from January 2010 to December 2019 were collected. There were 267 males and 60 females, aged 61(54,68)years. According to the specific situations of patients, treatment modalities included radical surgery combined with systemic treatment, palliative surgery combined with systemic treatment, and systemic treatment alone. Observation indicators: (1) clinical characteristics of patients who were treated by different modalities; (2) prognostic outcomes of patients who were treated by different modalities; (3) analysis of influencing factors for prognosis of patients with initially resectable GCLM; (4) screening of potential beneficiaries in patients who were treated by radical surgery plus systemic treatment and patients who were treated by palliative surgery plus systemic treatment. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. The Kaplan-Meier method was used to calculate survival rate and draw survival curve, and Log-Rank test was used for survival analysis. Univariate and multivariate analyses were conducted using the COX proportional hazard regression model. The propensity score matching was employed by the 1:1 nearest neighbor matching method with a caliper value of 0.1. The forest plots were utilized to evaluate potential benefits of diverse surgical combined with systemic treatments within the population. Results:(1) Clinical characteristics of patients who were treated by different modalities. Of 327 patients, there were 118 cases undergoing radical surgery plus systemic treatment, 164 cases undergoing palliative surgery plus systemic treatment, and 45 cases undergoing systemic treatment alone. There were significant differences in smoking, drinking, site of primary gastric tumor, diameter of primary gastric tumor, site of liver metastasis, and metastatic interval among the three groups of patients ( P<0.05). (2) Prognostic outcomes of patients who were treated by different modalities. The median overall survival time of the 327 pati-ents was 19.9 months (95% confidence interval as 14.9-24.9 months), with 1-, 3-year overall survival rate of 61.3%, 32.7%, respectively. The 1-year overall survival rates of patients undergoing radical surgery plus systemic treatment, palliative surgery plus systemic treatment and systemic treatment alone were 68.3%, 63.1%, 30.6%, and the 3-year overall survival rates were 41.1%, 29.9%, 11.9%, showing a significant difference in overall survival rate among the three groups of patients ( χ2=19.46, P<0.05). Results of further analysis showed that there was a significant difference in overall survival rate between patients undergoing radical surgery plus systemic treatment and patients undergoing systemic treatment alone ( hazard ratio=0.40, 95% confidence interval as 0.26-0.61, P<0.05), between patients undergoing palliative surgery plus systemic treatment and patients under-going systemic treatment alone ( hazard ratio=0.47, 95% confidence interval as 0.32-0.71, P<0.05). (3) Analysis of influencing factors for prognosis of patients with initially resectable GCLM. Results of multivariate analysis showed that the larger primary gastric tumor, poorly differentiated tumor, larger liver metastasis, multiple hepatic metastases were independent risk factors for prognosis of patients with initially resectable GCLM ( hazard ratio=1.20, 1.70, 1.20, 2.06, 95% confidence interval as 1.14-1.27, 1.25-2.31, 1.04-1.42, 1.45-2.92, P<0.05) and immunotherapy or targeted therapy, the treatment modality of radical or palliative surgery plus systemic therapy were independent protective factors for prognosis of patients with initially resectable GCLM ( hazard ratio=0.60, 0.39, 0.46, 95% confidence interval as 0.42-0.87, 0.25-0.60, 0.30-0.70, P<0.05). (4) Screening of potentinal beneficiaries in patients who were treated by radical surgery plus systemic treatment and patients who were treated by palliative surgery plus systemic treatment. Results of forest plots analysis showed that for patients with high-moderate differentiated GCLM and patients with liver metastasis located in the left liver, the overall survival rate of patients undergoing radical surgery plus systemic treatment was better than patients undergoing palliative surgery plus systemic treatment ( hazard ratio=0.21, 0.42, 95% confidence interval as 0.09-0.48, 0.23-0.78, P<0.05). Conclusions:Compared to systemic therapy alone, both radical and palliative surgery plus systemic therapy can improve the pro-gnosis of patients with initially resectable GCLM. The larger primary gastric tumor, poorly differen-tiated tumor, larger liver metastasis, multiple hepatic metastases are independent risk factors for prognosis of patients with initial resectable GCLM and immunotherapy or targeted therapy, the treatment modality of radical or palliative surgery plus systemic therapy are independent protective factors for prognosis of patients with initially resectable GCLM.