Objective To explore the effects of two methods of video laryngoscope insertion on the success rate of tracheal intubation and postoperative pharyngeal complications.Methods We selected 80 elective surgerypatients with American Society of Anesthesiologists(ASA)classification Ⅰ to Ⅱ who had no difficult airway in preoperative assessment under general anesthesia with orotracheal intubation.They were aged 18 to 65 years old and there were no restrictions on height and weight.The patients were randomly divided into a group with laryngoscope inserted through the middle of the mouth(group M)and a group with laryngoscope inserted through the right corner of the mouth(group C),with 40 cases in each group.Observe the laryngoscope exposure grading,oropharyngeal mucosal bleeding,first-time intubation success rate,and occurrence of pharyngeal pain and hoarseness within 48 hours after surgery in both groups;record the patients'systolic blood pressure(SBP),diastolic blood pressure(DBP),and heart rate(HR)among admission to the room(T0),after giving anesthesia drugs(T1),immediately after intubation(T2),1 min after intubation(T3),and 3 min after intubation(T4).Results The SBP of group M was lower than that of group C at T3(P＜0.05);There was no statistically significant difference in laryngoscope exposure grading between the two groups(P＞0.05).The intubation time,oropharynx mucosal bleeding and the cases of sore throat within 48 hours of group M were less than those in group C(P＜0.05).The success rate of primary intubation in group M was higher than that in group C(P＜0.05).Conclusion Inserting a video laryngoscope through the middle of the mouth can reduce oropharyngeal mucosal bleeding,improve the success rate of intubation,and reduce the incidence of postoperative pharyngeal complications.

Objective:To investigate the diagnostic value of cardiac magnetic resonance (CMR) contrast medium perfusion and delayed contrast enhancement for early myocardial ischemia.Methods:Ninety-one patients with coronary artery stenosis diagnosed by coronary angiography (CAG) between March 2020 and March 2022 in Yiwu Central Hospital were included in this study. These patients underwent first-pass perfusion cardiac magnetic resonance imaging and delayed enhancement examination. Arrival time ( t0), accumulative signal intensity (ASI), relative peak enhancement rate (SI%), maximum intensity of signal enhancement (SIp), and maximum curve slope (α) were statistically analyzed in the CMR contrast agent normal-dose perfusion and low-dose perfusion segments. The diagnostic value of CMR contrast agent perfusion versus CAG for early myocardial ischemia was determined. The signal intensity was compared between enhanced and non-enhanced areas of CMR contrast agent perfusion. Results:There were significant differences in ASI, SI%, SIp, and Slope (α) between normal perfusion and low perfusion segments ( t = 9.62, 10.65, 8.67, 6.93, all P < 0.05). There was no significant difference in the detection rate of lesioned vessels in early myocardial ischemia between CMR contrast agent perfusion and CAG [50.42% (120/238) vs. 51.68% (123/238), χ2 = 1.32, P = 0.163). There was a significant difference in the detection rate of lesioned vessels in myocardial ischemia between CMR contrast agent perfusion and CAG ( χ2 = 15.31, P < 0.001, r = 0.71). The signal intensity value in the delayed enhancement segment was significantly higher than that in the non-delayed enhancement segment [(598.43 ± 40.19) vs. (298.64 ± 70.58), t =19.85, P = 0.001). Conclusion:CMR contrast agent perfusion can effectively evaluate the severity of early myocardial ischemia and locate the diseased blood vessels. Delayed enhancement can determine the location and area of early myocardial ischemia, and can objectively reflect the severity of myocardial ischemia.

Objective To compare the effects of 4 different shaping angle tubes on the success rate of tracheal intubation and postoperative pharyngeal complications among anesthetic beginners.Methods 160 patients who underwent laparoscopic cholecystectomy under general anesthesia,with ASA classification Ⅰ to Ⅱ,no history of difficult airway,were randomly divided into 4 groups according to the catheter shape and tip shaping angle:35°banana-shaped elbow group(A Group),50°banana-shaped bent pipe group(Group B),35°straight pipe group(Group C),50°straight pipe group(Group D),with 40 cases in each group.After induction of general anesthesia,tracheal intubation is performed using a video laryngoscope.The Cormack-Lehane grade of laryngoscope exposure,external laryngeal compression,one-time success rate of intubation and intubation time were recorded.SPO2,HR and MAP were recorded before anesthesia induction(T0),at the end of anesthesia induction drug injection(T1),immediately after intubation(T2)and 1min after intubation(T3).The incidence of pharyngeal pain and hoarseness immediately after extubation and 24 hours after operation were followed up.Results There were no statistically significant differences in Cormack-Lehane classification,HR,and MAP among the four groups of patients at each time point(P>0.05).The number of cases requiring external laryngeal compression,intubation time,first-time intubation success rate,immediate postoperative sore throat,and immediate postoperative hoarseness rates in Groups B and D were all lower than those in Groups A and C,and the differences were statistically significant(P<0.05).Conclusion When using video laryngoscope for tracheal intubation,50°banana-shaped curved tube and 50°straight tube can shorten the intubation time,reduce postoperative complications,and have no obvious hemodynamic fluctuations.

Objective:To investigate the correlation between serum calcitonin gene-related peptide (CGRP) and the culture outcome of in vitro fertilization embryo in male patients with infertility.Methods:In this study, the randomized samples from 25 male patients who received in vitro fertilization-embryo transfer (IVF-ET) in the 1st Affiliated Hospital of Fujian Medical University from June 2019 to October 2019 were analyzed by multiple linear stepwise regression, with some important clinical outcomes, such as the logarithmic conversion index of serum CGRP, fertilization method, masturbation difficulty, age, infertility duration, and prolactin, as independent variables, while total fertilization rate, normal fertilization rate, high quality embryo rate at day 3, blastocyst formation rate as dependent variables.Results:The Pearson correlation analysis showed that the D3 high-quality embryo rate was related to the normal sperm morphology rate in the primary infertility group ( r=0.537, P=0.048), the blastocyst formation rate was correlated with sperm density ( r=0.760, P=0.002), the CGRP logarithm was correlated with the total fertilization rate ( r=0.693, P=0.006). The logarithmic conversion index of serum CGRP was related to the total fertilization rate and normal fertilization rate in the secondary infertility group ( r=0.614, P=0.042 and r=0.611, P=0.046). In the secondary infertility group, there was a linear relationship between normal fertilization rate and total sperm count, serum CGRP log conversion, and sperm normal morphology rate, with standardized regression coefficients of 0.2, -0.729, and 6.8, respectively. Conclusion:Serum CGRP level, together with total sperm count and normal sperm morphology rate may affects normal fertilization rate in male patients with infertility.

Hoffa fracture of tibial plateau is a special type of coronal fracture of tibial plateau, among which occult fracture accounts for a large proportion, resulting in missing diagnosis and delayed treatment. The current studies are all case reports, and the incidence, diagnostic protocol, injury characteristics and injury mechanism of Hoffa fracture have not been systematically studied. The commonly used classifications such as AO type, Schatzker type, three-column classification and comprehensive classification of tibial plateau cannot cover this type. In this study, a retrospective case series study was performed for the clinical data of 3 086 patients with tibial plateau fractures. There were 13 patients with Hoffa fracture of tibial plateau, and 23% of them were occult ones. The injury mechanism of this fracture was as follows: under the state of knee joint flexion, axial violence through femur concentrated on the posterior half of tibial plateau, with the knee joint in transient varus and pronation position, leading to the posteromedial coronal splitting fracture. According to the position and degree of fracture displacement involving the joint, the fracture was divided into three type: type I involving the articular surface of tibial plateau fracture less than 1/4, type II involving the articular surface of tibial plateau equal to or more than 1/4 and less than 1/2, type III involving the joint face equal to or more than 1/2. Each fracture type was divided into three subtypes, of which subtype A was non-displaced fracture, subtype B had articular surface displacement<2 mm, and subtype C had articular surface displacement≥2 mm. According to the classification characteristics, the treatment principles were proposed. The authors systematically summarized the Hoffa fracture of tibial plateau for the first time in aspects of the incidence, injury characteristics, injury mechanism, fracture classification and treatment principles, which is helpful to avoid missed diagnosis and improve treatment efficacy.

Objective:To understand and verify the biomechanical mechanism of tibial plateau Hoffa (coronal) fracture by simulating high-altitude falls and traffic injuries using knee joint specimens.Methods:Ten specimens of lower limb knee joint were used. They were from 6 males and 4 females, with an average age of 57.4 years (from 42 to 65 years). They were divided into 2 equal groups: one subjected to simulation of high-altitude falls (fall group) and the other to simulation of traffic injury (traffic injury group). After injury simulation, standard orthographic and lateral X-ray examinations and CT scans were performed of the knee joints in the extended position to observe whether there was a fracture, where the fracture occurred, and how the fracture line went.Results:A tibial plateau coronal fracture was successfully simulated in 6 cases, but not in the other 4 cases. The failure was attributed to femoral fractures and other types of tibial plateau fracture. In the 3 successful fractures simulated by high-altitude fall, the fracture line was located all on the posterior medial side, involving the posterior 1/3, 2/5, and 1/2 of the tibial plateau, respectively. The fracture line and the coronal plane formed angles of 21°, 19° and 12°, respectively. The fracture was not shown on X-ray film in one case which was a posterior medial fracture on CT. In the other 3 successful fractures simulated by traffic injury, the fracture line involved 1/6, 1/4 and 1/3 of the posterior tibial plateau, respectively. The angles between the fracture line and the coronal plane were 47°, 56° and 63°, respectively. One case showed no obvious fracture signs on the X-ray but a coronal fracture on CT.Conclusions:This study has confirmed for the first time that both high-altitude falls and traffic injuries can cause coronal fractures of the tibial plateau which vary significantly in the extent of involvement and morphology. X-rays are not sufficient to fully diagnose this type of fractures, suggesting that patients with a clear history of knee flexion or axial violence injury should be routinely scanned by CT to reduce risks of missed diagnosis and insufficient treatment.

Objective To explore the effect of Exendin-4 on dementia after traumatic brain injury (TBI) in rats and its related mechanism.Methods Thirty SD rats were randomly divided into sham group (n=10),TBI group(n=10) and Exendin-4 group(n=10).Cortical impact injury was used to construct the TBI model.Morris water maze test was used to test the memory function of rats one month after TBI.The beta-amyloid protein (Aβ1-42) and nuclear factor erythroid-2-related factor 2 (Nrf2) were detected by Western blot.Results One month after TBI compared with the sham group,the escape latency (EL) ((35.31 ± 13.23)s vs (8.79±9.71)s) was prolonged and the target quadrant stay time ((17.78±4.68)s vs (26.35± 5.83)s) was shortened,the number of crossing platforms ((1.40±1.75) vs (3.50±1.45)) decreased,the relative content of Aβ1-42 in hippocampus ((1.0140±0.0328) vs (0.4355±0.0152)) increased the relative content of tau protein ((0.8039±0.0251) vs (0.5170±0.0185)) increased,and Nrf2 expression levels ((0.3851±0.0188) vs (0.4901±± 0.0140)) decreased significantly,and the differences were statistically significant (t=5.110,3.625,4.068,16.010,9.208,4.474,all P＜0.01);Compared with TBI group,EL ((23.74±10.95) vs (35.31±13.23)) shortened,target quadrant dwell time ((24.28±5.37) vs (17.78±± 4.68)) shortened,the number of crossing platforms ((3.30±1.88) vs (1.40±1.75)) decreased,and the relative content of Aβ1-42 in hippocampus ((0.8370±0.0188) vs (1.0140±0.0328)) significantly decreased,the relative content of tau protein ((0.6693±0.0166) vs (0.8039±0.0251)) significantly decreased,and the expression level of Nrf2 ((0.4738 ± 0.0166) vs (0.3851 ± 0.0188)) significantly increased,and the differences were statistically significance (t=2.052,2.866,5.196,4.693,3.480,3.538,all P＜0.01).Conclusion Exendin-4 can significantly improve the learning and memory function of TBI rats,increase the expression of Nrf2,decrease the content of Aβ1-42 and tau in hippocampus,and improve the prognosis of neurological function of TBI rats.

Objective To investigate the efficacy of levosimendan and dobutamine in the treatment of dilated cardiomyopathy combined with refractory end-stage heart failure. Methods A total of 90 patients with dilated cardiomyopathy and refractory end-stage heart failure in our hospital from February 2016 to February 2017 were enrolled and grouped according to digital table method. The control group received conventional anti-heart failure treatment and dobutamine treatment. The observation group received conventional anti -heart failure treatment and levosimendan treatment. The treatment effects of dilated cardiomyopathy and refractory end-stage heart failure, the symptom improvement time, heart failure correction time, left ventricular ejection fraction, left ventricular end diastolic diameter, brain natriuretic peptide, cardiac index before and after intervention and drug side effects rate between two groups were compared. Results The treatment effect of dilated cardiomyopathy and refractory end -stage heart failure was higher in the observation group than that in the control group(P＜0. 05). The improvement time of symptoms and the correction time of heart failure in the observation group were shorter than those in the control group(P＜0. 05). The ventricular ejection fraction, left ventricular end diastolic diameter, brain natriuretic peptide, and cardiac index in two groups were similar (P＞0. 05). After the intervention, the left ventricular ejection fraction, left ventricular end diastolic diameter, brain natriuretic peptide, and cardiac index in the observation group were superior to those of the control group(P＜0. 05). There was no significant difference in drug side effects between the two groups, both of which were mild(P＞0. 05). Conclusion Levosi-mendan has a better effect in patients with dilated cardiomyopathy and refractory end-stage heart failure than dobu- tamine does. Levosimendan can improve heart function and correct heart failure more quickly, with high drug safety, and is worth promoting.

PURPOSE: Elevation in serum alanine aminotransferase (ALT) levels is a biomarker for metabolic syndrome (MS); however, the relationship has not been fully investigated within the reference interval of ALT levels. Our objective was to explore the relationship between serum ALT levels within the reference interval and MS in Chinese adults. MATERIALS AND METHODS: This cross-sectional study included 16028 adults, who attended routine health check-ups at Shengli Oilfield Central Hospital from January 2006 to March 2012. The reference interval of serum ALT level was defined as less than 40 U/L. Logistic regression models and restricted cubic spline were used to evaluate the association of ALT with MS. RESULTS: The prevalence of MS in the total population was 13.7% (6.4% for females and 18.4% for males). Multiple logistic regression showed that ALT levels were positively associated with MS after adjustment for potential confounding factors. The odds ratio of MS in the top quartile was 4.830 [95% confidence interval (CI): 2.980–7.829] in females and 3.168 (95% CI: 2.649–3.790) in males, compared with the ALT levels in the bottom quartile. The restricted cubic spline models revealed a positive non-linear dose-response relationship between ALT levels and the risk of MS in women (p for nonlinearity was 0.0327), but a positive linear dose-response relationship in men (p for nonlinearity was 0.0659). CONCLUSION: Serum ALT levels within the reference interval are positively associated with MS in a dose-response manner. Elevated ALT levels, even within the reference interval, may reflect early dysmetabolic changes.
Adult ; Aged ; Alanine Transaminase/*blood ; Asian Continental Ancestry Group ; Biomarkers/blood ; Confidence Intervals ; Cross-Sectional Studies ; Dose-Response Relationship, Drug ; Female ; Humans ; Logistic Models ; Male ; Metabolic Syndrome X/*enzymology/epidemiology ; Middle Aged ; Odds Ratio ; Prevalence ; Reference Values

Lao-Xiang-Huang (LXH) of Chaozhou is the processed product of Fructus Citri sarcodactylis.LXH from different producing areas were used as research objects in the study for the establishment of HPLC fingerprints of LXH.Contents of hesperidin and 5,7-dimethoxycoumarin were also determined to provide scientific basis for the establishment of quality standard of LXH.Samples were separated by an Agilent Eclipse XDB C18 column (4.6 mm × 250 mm,5 μm) using acetonitrile-0.1％ phosphoric acid with water gradient system as a mobile phase.The flow rate was 1.0 mL· min-1.The injection volume was 20 μL.The detection wavelength was at 283 nm.The results showed that HPLC fingerprint of LXH was established with good separation and repeatability.The similarity evaluation on 27 batches samples of LXH showed that there was a certain similarity on the HPLC fingerprints of LXH.However,there was a certain difference as a whole.Contents of hesperidin and 5,7-dimethoxycoumarin in LXH were simultaneously determined.It was concluded that the established HPLC fingerprint of LXH and content determination of hesperidin and 5,7-dimethoxycoumarin method were accurate,sensitive and repeatable.It provided scientific evidence for the quality control standard of LXH of Chaozhou.