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:To analyze the effects of mutiparity on the pelvic floor muscle and the best time of postpartum for pelvic floor rehabilitation intervention.Methods:By questionnaire survey and pelvic floor functional checking on women with 42 days postpartum clinic routine health checking,and following up pelvic floor muscles force exam in postpartum 3 months,6 months and 1 year,426 cases were included in the puerpera group,including primipara 325 cases as primiparous group,two birth multipara 101 cases as multiparous group,the damage of pelvic floor muscles(≤level Ⅱ) was compared between the two groups,the difference between multiparity and primiparity were compared.Results:①In postpartum 42 days,type Ⅰ muscle fiber damage rate was lower in multiparous group than that in primiparous group(P ＜0.05),there was no significant difference on the muscle fiber damage ratio (muscles force below Ⅲ) between the two groups (P ＞ 0.05).②)In postpartum 3 months,6 months,1 year there was no significant difference in proportion of muscle damage between the two groups (P ＞ 0.05).③Multiparous group pelvic floor muscle damage ratio decreased slowly and gradually in the four periods,there was no statistical difference between adjacent period (P ＞ 0.05),the pelvic muscle damage ratio appeared significant statistical difference between postpartum 6 months and postpartum 42 days(P ＜ 0.01).④In primiparous group,pelvic floor muscle damage ratio decreased significantly in postpartum 6 months,postpartum 42 days、3 months,6 months,the differces were statistically significant among the three times(P ＜ 0.05),there was no statistical difference between postpartum 6 months and 1 year(P＞0.05).Conclusions:Type Ⅰ muscle fibers suffer injury more in Primipara than that in multipara,multiparous pelvic floor muscle recovery process is more slowly than primipara's,we should pay attention to pelvic muscle recovery within 6 months after delivery.

Objective] To conclude the teacher Qiu's clinical experience and academic points on diagnosing and treating pregnancy with myasthenia gravis(MG). [Method] By reviewing relevant literature of traditional Chinese medicine, studying in clinic with teacher and tidying medical records, systematic mining and constructing teacher Qiu's clinical experience and academic points on etiology and pathogenesis, syndrome differentiation, medication thinking, drug characteristics, the taboo of drugs and combining traditional Chinese and western medicines treatment of pregnancy with myasthenia gravis(MG).[Results]Teacher Qiu thinks, pregnancy with MG involving spleen and kidney deficiency is the pathological process of pregnancy and physio-logical process of MG; Clinical syndrome differentiations can be divided into three types like temper deficiency, spleen and kidney deficiency, qi and Yin deficiency; establish the therapeutic rules of nourishing qi to invigorate spleen, tonifying the spleen and kidney and tonifying qi and yin. Respectively adding and subtracting Buzhong Yiqi Decoction with Taishan Panshi San, Buzhong Yiqi Decoction with aconitum lizhong pill and Taishan Panshi San, Buzhong Yiqi Decoction with sengmai san and Taishan Panshi San for syndrome differentiation treating the disease, nourishing qi to invigorate spleen and fetal irritability are the main treatments of the disease. Buzhong Yiqi Decoction and Taishan Panshi San are the basic prescriptions. Large dose of the astragalus membranaceus, atractylodes macrocephala koidz, Codonopsis pilosula,epimedium gradiflorum morr to tonify kidney strengthening spleen and supporting Qi in the prescription, combining traditional Chinese medicine with western medicine can reduce the use of western medicine and reduce the adverse reaction of western medicine. [Conclusion]The teacher Qiu's experience of syndrome differentiation and treatment on pregnancy complicating myasthenia gravis is rich, efficacy is got and has less side effect. It states that Chinese medicine treatment of pregnancy with MG has certain advantages and is worth being popularized and inheriting.

Objective] To sum up Qiu Changlin's clinical experience and academic views of treatment of multiple sclerosis remission stage. [Methods] Through the way of reviewing the related literature of traditional Chinese medicine, clinical practice with teacher, arranging medical records, systematically arranging Qiu Changlin's clinical experience and academic perspective in the aspects of etiology and pathogenesis, syndrome differentiation ,treatment ideas, drug integration of TCM and western medicine. [Results] Qiu Changlin believes that the MS remission stage is of deficiency syndrome or deficiency complicated with excess syndrome. The main pathogenesis is insufficiency of kidney yin and kidney yang, deficiency of governor vessel. The subject is wind and phlegm attacking into collateral, stagnation of phlegm and blood stasis. Put forward that the treatment based on the differentiation between the main syndrome and minor syndrome. In clinic, divided the main syndrome into three types, like insufficiency of kidney yin, insufficiency of kidney yang, insufficiency of kidney essence. Establish the therapeutic principles like nourishing yin and kidney, warming yang and nourishing kidney, the complementing of yin and yang, dispelling wind and dredging collaterals. The kidney yin deficiency type can modify Six Ingredient Rehmannia pill, Zhibaidihuang pill, Zuogui pill, Dabuyin pill, Huqian pill. The kidney yang deficiency type can modify Jingui Shenqi pill, Yougui pill. The kidney essence deficiency type can modify Dihuangyinzi. Regard that nourishing kidney and governing vessel to the fundamental treatment, ants going into collaterals to dispel the blood stasis and wind for treatment of the symptoms, and believe that nourishing kidney and extinguish wind should always run through the whole treatment process. When treatment based on the main syndrome, we should emphasize personalized features that can reflect the characteristics of this disease, in order to improve the clinical curative effect. [Conclusion] Qiu Changlin has rich clinical experience in the treatment of MS remission stage;patients are satisfactory to the curative effect and have fewer side effects. It's fully explained that TCM has certain advantages in the treatment of MS remission stage, and is worth popularizing inheritance.

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.

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.

Objective To explore the value of ultrasonographic diagnosis of deltoid contracture (DC). Methods A total of 37 children with bilateral asymmetric shoulder were reviewed retrospectively, and 8 cases with 9 shoulders were surgically confirmed DC. The results of the ultrasonography and surgery were compared. Results The sensitivity of ultrasonographic diagnosis of DC was 88.89% and specificity was 100%. No statistically significant difference of contracture thickness measurement was found between surgery and ultrasonography. Ultrasonographic findings of DC in children included hyperechoic areas (7 cases) or hypoechoic area (1 case). Conclusion Ultrasounogrphy is an effective method for diagnosis of DC in children.

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.