Objective:To explore the application and safety of visual endotracheal tube in tracheal intubation in patients with gen eral anesthesia operation.Methods:220 patients with general anesthesia operation in Department of Anesthesiology,Guangdong No.2 provincial people's hospital firom October 2014 to December 2016 were selected,110 patients were treated with visual endotracheal intubation as observation group,110 patients were treated with general endotracheal intubation as control group.The number of intubation,intubation times and complication rate in the two groups were contrasted,compared the heart rate (HR),systolic blood pressure (SBP),diastolic blood pressure (DBP) and oxygen saturation (SpO2) in the two groups at before induction of anesthesia (T0),after induction of anesthesia (T1),airway intubation (T2),5 min after intubation (T3).Results:The number of intubation and intubation times in the observation group were significantly less than those in the control group,the differences were statistically significant (P＜0.05);At each time point,the HR,SBP,DBP and SpO2 in the two groups were no significant difference (P＞0.05);The HR,SBP,DBP and SpO2 in the two groups at T1 were significantly less than T0,T2,T3,the differences were statistically significant (P＜0.05);The incidence of throat pain in the observation group (0.91％) was significantly less than that in the control group (7.27％),the difference was statistically significant (P＜0.05).Conclusion:Use visual endotracheal tube in tracheal intubation in patients with general anesthesia operation is satisfactory,can effectively reduce the time of intubation and intubation times,and has good security,it is worthy of clinical application.

Objective To investigate levels of IL-17 and IL-22 mRNA in the blood of type 2 diabetes(T2DM)patients with the different stages of kidney injury and explore the relationship between the gene expression levels of IL-17,IL-22 and renal lesions in patients with diabetic nephropathy(DM).Methods Subjects included 60 T2DM patients with or without kidney injury and 20 normal controls(NC,n=20).Diabetes patients were divided into 3 groups by level of urinary albumin to creati-nine ratio (ACR):no proteinuria group (NA,ACR<30 mg/g,n=22),microalb uminuria group (MA,30 mg/g>ACR>300 mg/g,n=18)and diabetic nephropathy group (DN,ACR>300 mg/g,n=20).Quantitative Real-Time RT-PCR was used to detect IL-17 and IL-22 mRNA levels.Analysis differences of IL-17 and IL-22 mRNA levels among NA,MA,DN and NC groups.Results The levels of IL-17 and IL-22 mRNA were significantly higher in DN group than that in MA,NA and NC group (P <0.01,respectively),However,there were not significant difference among MA,NA and NC group (P >0.05,re-spectively).Conclusion Levels IL-17 and IL-22 mRNA were increased in blood of T2DM patients with nephropathy.IL-17 and IL-22 may play role in the pathogenicity of diabetic nephropathy.

This article analyzes and summaries the problems and difficulties existing in the first-aid medicine's clinical teaching.Combined with his own teaching experience,the author has made some exploration on the teaching time,the way of teaching and inspection form,which has got a good teaching effect.It provids the reference and development for the clinical teaching of first-aid medicine.

Objective To discuss the value of MR T2 mapping in the research of the biomechanics and function of cartilage of knee joint.Methods Knees of 20 healthy adults before and after jogging and 19 osteoarthritis patients were examined with sagittal 8-echo SE sequence.The T2 value of cartilage was selected and calculated.The T2 values in the superficial and deep cartilage of femoral and tibial joint before and after jogging were compared,so did between the osteoarthritis patients and healthy adults.The source images were sent to the workstation to get T2 mappings.The T2 value of cartilage between before and after jogging was compared with paired-samples t test.The T2 value between superficial and deep cartilage before jogging was compared with independent-samples t test,so did between the osteoarthritis patients and healthy adults.Results The T2 values in the superficial and the deep tibial cartilage were(48.8±6.3)ms,(44.3±5.7)ms before jogging and(43.4±5.0)ms,(40.3±6.1)ms after jogging.The T2 values were significantly different between before and after jogging(t=6.004 and t=5.037,P＜0.05).There was a significant difference between superficial and deep tibial cartilage before jogging(t=3.148,P＜0.01).The T2 Values in the superficial and deep femoral cartilage were(52.1±5.7)ms,(47.7±5.3)ms before jogging and(47.2±4.5)ms,(43.6±4.1)ms after jogging.The T2 values were significantly different between before and after jogging(t=6.169 and t=5.957,P＜0.05).There was a significant difference between superficial and deep femoral cartilage before jogging(t=3.384,P＜0.01).The T2 mapping showed those changes.The mean T2 value in the tibial cartilage of osteoarthritis patients was(56.0±9.1)ms and was higher than that of healthy adults.There was a significent difference between osteoarthritis patients and healthy adults(t=-3.446,P＜0.01).Conclusion T2 mapping can be used in the research of biomechanics and function of cartilage and has a prelimilary value in the diagnosis of cartilage degeneration.

Objective To investigate the safety,diagnostic value and clinical impact of double balloon enteroscope (DBE) in elderly patients (aged ≥75 years).Methods Clinical data and DBE findings of elderly patients in the Department of Gastroenterology in Remin Hospital of Wuhan University from January 2010 to January 2013 were retrospectively analyzed and compared with those of younger patients.Results The diagnostic rate,complication rate and clinical impact rate were 69.0％ (29/42),0％ (0/42) and 76.2％ (32/42) in elderly patients.There were no statistically significant differences on those parameters between elderly patients and younger patients (all P＞0.05).For elderly patients,the leading causes of obscure gastrointestinal bleeding (OGIB) were tumor (30.0 ％,9/30) and ulcer (16.7 ％,5/30),while angiectasis (6.7 ％,2/30) was uncommon.Conclusions DBE is an effective and safe method for diagnosis of small bowel disease in elderly patients.Tumor is the most common cause of OGIB,while angiectasis was uncommon.

Objective To investigate the effect of slice orientation on the popliteomeniscal fasciculi (PMF) MR imaging and its normal MRI appearances. Methods Volumetric MRI data of 40 knees of healthy volunteers were acquired using an isotropic 3D turbo spin echo (TSE) MR sequence. The posterior tangential line to both femoral condyles was used as the reference line, and the long axis sectional images of the popliteal hiatus region were reformatted at 0°, 15°, 30°, 45°, 60°, 75° and 90° to the reference line. The MRI appearances of the PMF were scored respectively and classified. The final scores of the PMF at each slice angle were statistically analyzed by a repeated measure ANOVA. Results At 0°, 15°, 30°, 45°, 60°, 75° and 90° slice angles: scores of the anteroinferior fasciculi were (1.7±0.7), (1.8±0.6), (1.9±0.6), (2.0±0.7), (1.9±0.7), (1.8±0.8) and (1.0±0.5),respectively. Scores of the posterosuperior fasciculi were (1.5±0.7), (1.9±0.7), (2.1±0.6), (2.2±0.6),(2.2±0.6), (2.0±0.8) and (1.7±0.8), respectively. There were statistically significant differences in the average scores at each slice angle for both anteroinferior fasciculi (F = 29.744, P = 0.000) and posterosuperior fasciculi (F = 19.770,P =0.000). The anteroinferior fasciculi and the posterosuperior fasciculi had highest average scores at the angle of 45°. The percentage of type A, B and C of anteroinferior fascicali were 20.0% (8/40), 75.0% (30/40) and 5.0% (2/40), respectively. The percentage of type A, B and C of posterosuperior fasciculi were 37.5% (15/40) ,62.5% (25/40) and 0% (0/40) ,respectively. Conclusion The anteroinferior fasciculi and the posterosuperior fasciculi can be well depicted at the angle of 45° slice orientation.

ObjectiveTo find out the effect of improving cooking stove to reduce fluoride in burning coal fluorosis areas in Ankang city Shaanxi province,and to provide a basis for continuing the consolidation of control measures and the elimination of the hazards of burning coal fluorosis.Methods According to the results of a census of 2001 in Ankang city on burning coal fluorosis,cluster sampling method was used in 2009,and 10％ of the diseased villages were included in the study according to the state of the disease(mild,moderate and severe) in seven counties.In each selected village 10 households were selected,and the quality of improved stoves was checked door to door,maintenance and satisfaction of the stoves were asked on the spot,and health education questionnaire was carried out among housewives.Thirty village primary schools were investigated,dental fluorosis of children aged 8 to 12 was checked by Dean method,urinary fluoride was tested by ion selective electrode,health education and knowledge questionnaire survey was curried out.Results A total of 1000 households were investigated in the seven diseased counties,and the completion rate of improved stoves was 90.00％ (900/1000);the rate of improved stoves in good condition was 87.14％ (630/723); overall use of improved stoves was 80.33％(723/900); proper use of improved stoves was 79.39％ (574/723),satisfaction rate of improved stoves was 86.89％(782/900),and self-maintenance of improved stoves was 8.00％(72/900).Total detection rate of dental fluorosis of children aged 8 to 12 was 23.74％(509/2144),dental fluorosis index was 0.50.Awareness of prevention knowledge among housewives and students was 65.20％ (2608/4000) and 83.36％(4518/5420),respectively.A total of 358 urine samples of children aged 8 to 12 were tested,urine fluoride ranged 0.16 - 6.35 mg/L,and geometric mean 0.79 mg/L.Conclusions The implementation of defluoridation project by improving cooking stove has achieved the goal of prevention and treatment of fluoride poisoning in burning coal fluorosis areas of Ankang city.Local residents are satisfied with the improved stoves,and most of the improved stoves are used constantly.The detection rate of dental fluorosis is less than 30％ of the control line.Some furnace are damaged,correct usage rate is not high.There is a need to further strengthen the management of the project and strengthen health education interventions to improve stove maintenance outlets,and make sustained control of the disease.

Objective To assess the value of double balloon enteroscopy (DBE) in etiological diagnosis of small bowel ulcer.Methods The clinical and endoscopic data of patients undergoing DBE at the Department of Gastroenterology, Renmin Hospital of Wuhan University from January 2010 to January 2016 were reviewed.For patients with small bowel ulcer revealed by DBE, the etiologic diagnosis was retrospectively analyzed.Results One hundred and three patients with small bowel ulcer were included in the analysis.The initial diagnosis based on morphology of ulcer was Crohn's disease (58.3%, 60/103), intestinal tuberculosis (18.4%,19/103), etiology unknown (24.3%, 25/103).The final diagnosis comprehensively based on pathology, clinical data and disease outcome was Crohn's disease (44.7%,46/103), intestinal tuberculosis (18.4%,19/103), lymphoma (3.8%,4/103), eosinophils enteritis (1.9%,2/103), non-steroidal anti-inflammatory drug enteritis (1.9%,2/103), adenocarcinoma (1.0%,1/103), stroma tumor (1.0%,1/103),ischemic enteritis (1.0%,1/103), vascular malformation (1.0%,1/103), Henoch-Schonlein purpura (1.0%,1/103), etiology unknown (24.3,25/103).The accurate diagnosis rate and misdiagnosis rate for Crohn's disease by DBE were 73.3%(44/60)and 10.0%(6/60).The accurate diagnosis rate and misdiagnosis rate for intestinal tuberculosis by DBE were 14/18 and 2/18.Conclusion There are diversity and complexity in etiologic diagnosis of small bowel ulcer.The diagnosis should be based on the comprehensive analysis of morphology of ulcer, endoscopic and surgical pathology and clinical data.Follow up of small bowel ulcer by DBE may provide important information for etiologic diagnosis.

Objective To explore an effective method in reconstructing of burn scar contracture of the chin and neck in children. Methods The blood in the transverse cervical artery might flow reverse into the suprascapular artery and the posterior intercostals perforators through anastomic branches. An axial skin flap in the cervico-scapulo-dorsal area could be adequately supplied by this artery, and we had therefore used this flap to repair burn scar in the neck. Results 30 cases obtained satisfactory clinical results with this flap. The follow-up for two years in 18 patients showed that the neck of the patients moved about freely, and the develpment of the chin was not influenced, and the color of flaps was fine. Conclusion The blood supply of the flap is reliable and stable. So it is a very useful method in reconstructing the burn scar of the chin-neck in children.

Objective To explore ear reconstruction using autologous rib cartilage ear framework by multi-layer spliced sculpture in microtia patients.Methods From Feb 2010 to May 2011,29 microtia patients were subjected to ear reconstruction using autologous rib cartilage ear framwork by four-layer spliced sculpture.Results In one operation 29 patients achieved 2 cm transverse height of reconstructed ears which were basically coincidence with the normal side.Patents and their families were all satisfied with the results.Follow-up of 3-12 months showed that only 1 case reconstructed-ear height was significantly lower transverse process.Owing to sleeping position,the patient did not protect the reconstructed ear,leading to frequent reconstructed-ear pressure.Conclusions The method of multi-layer spliced sculpture autologous rib cartilage ear reconstruction has good clinical effect.It can make reconstructed ear reach nomal transverse height and avoid the third rib cartilage transplant operation to continue increasing the transvers height.