BackgroundSleep disorder in the first trimester is a fairly common health problem， and previous studies have mainly reflected the overall sleep quality through scale assessments， which may not accurately capture the differences among various subtypes. ObjectiveTo explore the latent profiles of sleep quality in first-trimester pregnant women and identify the physiological， psychological and social factors， in order to provide practical references for the development of personalized interventions for sleep disorders in first-trimester pregnant women. MethodsA total of 1 066 first-trimester pregnant women who visited the obstetric outpatient clinic of a tertiary A hospital in Shenzhen from October 2021 to October 2022 were investigated using the general information questionnaire， Pittsburgh Sleep Quality Index （PSQI）， Edinburgh Postnatal Depression Scale （EPDS）， Chinese version of short International Physical Activity Questionnaire （IPAQ-S-C） and Social Capital Assessment Tool in Pregnancy for Maternal Health （SCAT-MH）. Then the sleep profiles were identified through latent profile analysis， and the robust mixture regression model was employed to determine the influencing factors of sleep profiles. ResultsA 3-profile solution showed the best fit： 732 cases （68.67%） of good sleep quality group， 87 cases （8.16%） of low sleep efficiency group， and 247 cases （23.17%） of daytime dysfunction group. In comparison with subjects in good sleep quality group， first-trimester pregnant women in low sleep efficiency group were at a younger age （OR=0.951， 95% CI： 0.922~0.980）， held a Bachelor's degree or above （OR=1.869， 95% CI： 1.260~2.773） and exhibited lower levels of social capital （OR=0.962， 95% CI： 0.951~0.973）， while those in daytime dysfunction group were at an older age （OR=1.072， 95% CI： 1.027~1.120） and had higher levels of depression （OR=1.166， 95% CI： 1.115~1.218）. Pregnant women who were workers （OR=0.507， 95% CI： 0.293~0.876） were less likely to report daytime dysfunction. ConclusionThree latent profiles with significant heterogeneity are derived from the sleep quality of first-trimester pregnant women， and levels of depression and social capital are the main influencing factors of sleep quality. ［Funded by Industry-University-Research Innovation Fund for Chinese Universities （number， 2023HT018）］

Objective To compare the safety and adverse effects of esketamine alone or fentanyl combined with propofol for interventional occlusion of congenital heart disease in children,so as to provide a more suitable sedation and analgesia plan for these patients.Methods A prospective randomized controlled study was adopted.A total of 104 cases of congenital heart disease,including 53 cases of atrial septal defect(ASD),31 cases of ventricular septal defect(VSD),and 20 cases of patent ductus arteriosus(PDA),who underwent interventional occlusion under general anesthesia while preserving spontaneous breathing from January to March 2025,were taken as the research subjects.The children were divided into two groups by random number table method:esketamine group(group ES)and fentanyl+propofol group(group AP),with 52 cases in each group.The children in the group ES and the group AP were anesthetized by esketamine 0.5 mg/kg and fentanyl 2 ug/kg+propofol 2.5 mg/kg,respectively,and sevoflurane inhalation anesthesia was maintained during the operation.The mean arterial pressure(MAP),heart rate(HR),respiratory rate(RR)and pulse oxygen saturation(SpO2)were recorded at the time of entry(T0),1 min after induction of general anesthesia(T1),femoral artery puncture(T2),occluder insertion(T3),recovery(T4),and 10 min after recovery(T5).The operation time,dosage of sevoflurane,anesthesia induction time and recovery time of the two groups were recorded.The occurrence of adverse events during general anesthesia was recorded,including hypoxemia after general anesthesia induction,respiratory depression and intraoperative body movement,restlessness during the recovery period,and increased secretion during the recovery period.Results There were significant differences in MAP,HR,SpO2 and RR in time points within each group,between two groups,and across the time×group interaction(P<0.05).There was no significant difference in operation time,dosage of sevoflurane,anesthesia induction time,and recovery time between the two groups(P>0.05).The incidence of hypoxemia in the group ES was significantly lower than that in the group AP[1.9%(1/52)vs.28.9%(15/52),χ2=14.477,P=0.000],the incidence of respiratory depression in the group ES was significantly lower than that in the group AP[0.0%(0/52)vs.11.5%(6/52),P=0.027],and the incidence of intraoperative body movement in the group ES was significantly lower than that in the group AP[0.0%(0/52)vs.11.5%(6/52),P=0.027].Conclusions During the three interventional occlusion procedures for congenital heart disease in children,compared with fentanyl combined with propofol injection,esketamine can better maintain the stability of respiratory circulation,and has a lower incidence of adverse events such as intraoperative hypoxemia,respiratory depression and intraoperative body movement.Compared with traditional anesthetic drugs,eketamine can be used as a better choice for sedation and analgesia during interventional occlusion for the three types of congenital heart diseases in children.

Objective:To investigate the role of microRNA-25-5p (miR-25-5p) in melanogenesis, and to explore its underlying mechanisms.Methods:Target genes of miR-25-5p were predicted using the TargetScan database. The interaction between miR-25-5p and the 3' untranslated region (3' UTR) of the RAB11B gene (a member of RAS oncogene family) was validated through a dual-luciferase reporter assay. Post-inflammatory hyperpigmentation (PIH) models were established in female C57BL/6J mice (6 - 8 weeks old) and female brown guinea pigs (4 - 6 weeks old) through daily broadband ultraviolet B (UVB) irradiation on the dorsal skin of the mouse ear or shaved dorsal skin of guinea pigs, while untreated mice and untreated dorsal skin areas of guinea pigs served as control groups. During modeling, these experimental animals received intradermal injections of a miR-25-5p agomir or a miR control agomir. Changes in skin pigmentation were observed, and skin tissue samples were harvested for further analysis after modeling. Melanin content in skin tissues was evaluated using Masson-Fontana staining. Expression of RAB11B and tyrosinase (TYR) in skin tissues was determined using immunohistochemical staining and quantitative real-time PCR (qPCR). Primary human melanocytes were isolated from discarded normal foreskin tissues of healthy males after circumcision. Both primary human melanocytes and human MNT1 melanoma cells were transfected with miR-25-5p mimics or miR control mimics. Relative expression levels of miR-25-5p and RAB11B mRNA were quantified by qPCR using the 2 -ΔΔCt calculation method. In MNT1 cells, miR-25-5p and RAB11B were co-overexpressed to assess their effect on the mRNA expression of RAB11B and TYR. Statistical analysis was conducted using t test or one-way analysis of variance followed by Tukey's post hoc test for multiple comparisons. Results:The bioinformatic prediction and dual-luciferase reporter assay confirmed a binding site for miR-25-5p in the 3′ UTR of the RAB11B gene. In both animal models, the treatment with the miR-25-5p agomir significantly reduced local skin pigmentation compared to the control groups; Masson-Fontana staining showed a marked decrease in the density of melanin granules in the epidermis and dermis in the miR-25-5p agomir groups compared with the miR control agomir groups (mice: 0.050 ± 0.005 vs. 0.087 ± 0.008; guinea pigs: 0.067 ± 0.015 vs. 0.110 ± 0.013; both P < 0.05). Immunohistochemical staining revealed significantly lower expression of RAB11B in mouse skin tissues in the miR-25-5p agomir group than in those in the miR control agomir group (both P < 0.05). qPCR revealed significantly lower mRNA expression of RAB11B and TYR in skin tissues of guinea pigs in the miR-25-5p agomir group than in those in the miR control agomir group (both P < 0.05). Similarly, RAB11B mRNA expression significantly decreased in the miR-25-5p mimics group compared with the miR control mimics group in primary human melanocytes and MNT1 cells (both P < 0.05). In human MNT1 melanoma cells, miR-25-5p overexpression could suppress TYR mRNA expression, whereas co-overexpression of miR-25-5p and RAB11B could reverse this suppression. Conclusion:Overexpression of miR-25-5p could alleviate UVB-induced post-inflammatory hyperpigmentation and inhibit melanogenesis, likely by targeted suppression of RAB11B expression.

Objective:To investigate the role of microRNA-25-5p (miR-25-5p) in melanogenesis, and to explore its underlying mechanisms.Methods:Target genes of miR-25-5p were predicted using the TargetScan database. The interaction between miR-25-5p and the 3' untranslated region (3' UTR) of the RAB11B gene (a member of RAS oncogene family) was validated through a dual-luciferase reporter assay. Post-inflammatory hyperpigmentation (PIH) models were established in female C57BL/6J mice (6 - 8 weeks old) and female brown guinea pigs (4 - 6 weeks old) through daily broadband ultraviolet B (UVB) irradiation on the dorsal skin of the mouse ear or shaved dorsal skin of guinea pigs, while untreated mice and untreated dorsal skin areas of guinea pigs served as control groups. During modeling, these experimental animals received intradermal injections of a miR-25-5p agomir or a miR control agomir. Changes in skin pigmentation were observed, and skin tissue samples were harvested for further analysis after modeling. Melanin content in skin tissues was evaluated using Masson-Fontana staining. Expression of RAB11B and tyrosinase (TYR) in skin tissues was determined using immunohistochemical staining and quantitative real-time PCR (qPCR). Primary human melanocytes were isolated from discarded normal foreskin tissues of healthy males after circumcision. Both primary human melanocytes and human MNT1 melanoma cells were transfected with miR-25-5p mimics or miR control mimics. Relative expression levels of miR-25-5p and RAB11B mRNA were quantified by qPCR using the 2 -ΔΔCt calculation method. In MNT1 cells, miR-25-5p and RAB11B were co-overexpressed to assess their effect on the mRNA expression of RAB11B and TYR. Statistical analysis was conducted using t test or one-way analysis of variance followed by Tukey's post hoc test for multiple comparisons. Results:The bioinformatic prediction and dual-luciferase reporter assay confirmed a binding site for miR-25-5p in the 3′ UTR of the RAB11B gene. In both animal models, the treatment with the miR-25-5p agomir significantly reduced local skin pigmentation compared to the control groups; Masson-Fontana staining showed a marked decrease in the density of melanin granules in the epidermis and dermis in the miR-25-5p agomir groups compared with the miR control agomir groups (mice: 0.050 ± 0.005 vs. 0.087 ± 0.008; guinea pigs: 0.067 ± 0.015 vs. 0.110 ± 0.013; both P < 0.05). Immunohistochemical staining revealed significantly lower expression of RAB11B in mouse skin tissues in the miR-25-5p agomir group than in those in the miR control agomir group (both P < 0.05). qPCR revealed significantly lower mRNA expression of RAB11B and TYR in skin tissues of guinea pigs in the miR-25-5p agomir group than in those in the miR control agomir group (both P < 0.05). Similarly, RAB11B mRNA expression significantly decreased in the miR-25-5p mimics group compared with the miR control mimics group in primary human melanocytes and MNT1 cells (both P < 0.05). In human MNT1 melanoma cells, miR-25-5p overexpression could suppress TYR mRNA expression, whereas co-overexpression of miR-25-5p and RAB11B could reverse this suppression. Conclusion:Overexpression of miR-25-5p could alleviate UVB-induced post-inflammatory hyperpigmentation and inhibit melanogenesis, likely by targeted suppression of RAB11B expression.

Objective To compare the safety and adverse effects of esketamine alone or fentanyl combined with propofol for interventional occlusion of congenital heart disease in children,so as to provide a more suitable sedation and analgesia plan for these patients.Methods A prospective randomized controlled study was adopted.A total of 104 cases of congenital heart disease,including 53 cases of atrial septal defect(ASD),31 cases of ventricular septal defect(VSD),and 20 cases of patent ductus arteriosus(PDA),who underwent interventional occlusion under general anesthesia while preserving spontaneous breathing from January to March 2025,were taken as the research subjects.The children were divided into two groups by random number table method:esketamine group(group ES)and fentanyl+propofol group(group AP),with 52 cases in each group.The children in the group ES and the group AP were anesthetized by esketamine 0.5 mg/kg and fentanyl 2 ug/kg+propofol 2.5 mg/kg,respectively,and sevoflurane inhalation anesthesia was maintained during the operation.The mean arterial pressure(MAP),heart rate(HR),respiratory rate(RR)and pulse oxygen saturation(SpO2)were recorded at the time of entry(T0),1 min after induction of general anesthesia(T1),femoral artery puncture(T2),occluder insertion(T3),recovery(T4),and 10 min after recovery(T5).The operation time,dosage of sevoflurane,anesthesia induction time and recovery time of the two groups were recorded.The occurrence of adverse events during general anesthesia was recorded,including hypoxemia after general anesthesia induction,respiratory depression and intraoperative body movement,restlessness during the recovery period,and increased secretion during the recovery period.Results There were significant differences in MAP,HR,SpO2 and RR in time points within each group,between two groups,and across the time×group interaction(P<0.05).There was no significant difference in operation time,dosage of sevoflurane,anesthesia induction time,and recovery time between the two groups(P>0.05).The incidence of hypoxemia in the group ES was significantly lower than that in the group AP[1.9%(1/52)vs.28.9%(15/52),χ2=14.477,P=0.000],the incidence of respiratory depression in the group ES was significantly lower than that in the group AP[0.0%(0/52)vs.11.5%(6/52),P=0.027],and the incidence of intraoperative body movement in the group ES was significantly lower than that in the group AP[0.0%(0/52)vs.11.5%(6/52),P=0.027].Conclusions During the three interventional occlusion procedures for congenital heart disease in children,compared with fentanyl combined with propofol injection,esketamine can better maintain the stability of respiratory circulation,and has a lower incidence of adverse events such as intraoperative hypoxemia,respiratory depression and intraoperative body movement.Compared with traditional anesthetic drugs,eketamine can be used as a better choice for sedation and analgesia during interventional occlusion for the three types of congenital heart diseases in children.

Background Salidroside (SAL) has a protective effect on multiple organ systems. Exposure to fine particulate matter (PM_2.5) in the atmosphere may lead to disruptions in gut microbiota and impact intestinal health. The regulatory effect of SAL on the gut microbiota of mice exposed to PM_2.5 requires further investigation. Objective To evaluate gut microbiota disruption in mice after being exposed to PM_2.5 and the potential effect of SAL. Methods Forty male C57BL/6 mice, aged 6 to 8 weeks, were randomly divided into four groups: a control group, an SAL group, a PM_2.5 group, and an SAL+PM_2.5 group, each containing 10 mice. In the SAL group and the SAL+PM_2.5 group, the mice were administered SAL (60 mg·kg⁻¹) by gavage, while in the control group and the PM_2.5 group, sterile saline (10 mL·kg⁻¹) was administered by gavage. In the PM_2.5 group and the SAL+PM_2.5 group, PM_2.5 suspension (8 mg·kg⁻¹) was intratracheally instilled, and in the control group and SAL group, sterile saline (1.5 mL·kg⁻¹) was intratracheally administered. Each experiment cycle spanned 2 d, with a total of 10 cycles conducted over 20 d. Histopathological changes in the ileum tissue of the mice were observed after HE staining. Colon contents were collected for gut microbiota sequencing and short-chain fatty acids (SCFAs) measurements. Results The PM_2.5 group showed infiltration of inflammatory cells in the ileum tissue, while the SAL+PM_2.5 group exhibited only a small amount of inflammatory cell infiltration. Compared to the control group, the PM_2.5 group showed decreased Shannon index (P<0.05) and increased Simpson index (P<0.05), indicating that the diversity of gut microbiota in this group was decreased; the SAL+PM_2.5 group showed increased Shannon index compared to the PM_2.5 group (P<0.05) and decreased Simpson index (P<0.05), indicating that the diversity of gut microbiota in mice intervened with SAL was increased. The principal coordinates analysis (PCoA) revealed a significant separation between the PM_2.5 group and the control group, while the separation trend was less evident among the control group, the SAL group, and the SAL+PM_2.5 group. The unweighted pair-group method with arithmetic means (UPGMA) clustering tree results showed that the control group and the SAL group clustered together first, followed by clustering with the SAL+PM_2.5 group, and finally, the three groups clustered with the PM_2.5 group. The PCoA and UPGMA clustering results indicated that the uniformity and similarity of the microbiota in the PM_2.5 group were significantly decreased. Compared to the control group, the PM_2.5 group showed decreased abundance of phylum Bacteroidetes and Candidatus_Saccharimonas (P<0.05) and increased abundance of phylum Proteobacteria, genus Escherichia, genus Bacteroides, genus Prevotella, genus Enterococcus, and genus Proteus (P<0.05). Compared to the PM_2.5 group, the SAL+PM_2.5 group showed decreased abundance of phylum Proteobacteria, phylum Actinobacteria, genus Prevotella, and genus Proteus (P<0.05), and increased abundance of Candidatus_Saccharimonas (P<0.05). The PM_2.5 group showed reduced levels of propionic acid, valeric acid, and hexanoic acid compared to the control group (P<0.05), while the SAL+PM_2.5 group showed increased levels of propionic acid, isobutyric acid, butyric acid, valeric acid, and hexanoic acid compared to the PM_2.5 group (P<0.05). Conclusion Exposure to PM_2.5 can cause pathological alterations, microbial dysbiosis, and disturbing production of SCFAs in intestinal tissue in mice. However, SAL can provide a certain degree of protective effect against these changes.

Objective To observe the effect of Lactobacillus casei(L.casei)on the depression-like behaviors of offspring rats induced by maternal separation(MS),and explore the potential action mechanism of probiotics to improve central nervous inflammation in depression-like behaviors.Methods MS stress was used to establish a depressed animal model in offspring.Female SD rats were randomly divided into control group(CON),MS group,and MS+L.casei group,with 8 animals in each group.The female rats and their offspring in the control group did not undergo MS intervention after delivery,while those in the MS group were separated 3 h each day,for 14 consecutive days after normal delivery.The offspring of the MS+L.casei group was given intervention of 8 ×108 CFU/(kg·d)L.casei gavage for 4 weeks.Source preference test(SPT)and forced swimming test(FST)were used to evaluate the changes in depressive behaviors of the offspring rats.ELISA was employed to determine the levels of TNF-α,IL-6,IL-1 β and IL-10 in serum and hippocampus tissue.Real-time fluorescence quantitative PCR was applied to detect the mRNA expression levels of indoleamine 2,3-dioxygenase-1(IDO1)and 5-HT mRNA in hippocampus.Results Compared with the CON group,the offspring in the MS group had significantly reduced percentage of source preference(P＜0.05),prolonged immobility time during forced swimming(P＜0.05),and decreased number of grid crossings in spontaneous activity test(though no statistical difference),indicating that the offspring rats had obvious depression-like behaviors after MS.L.casei treatment improved the behavioral changes of offspring rats caused by MS stress,with significantly increased percentage of source preference(P＜0.05)and shortened immobility time of forced swimming(P＜0.05).Compared with the conditions in the MS group,L.casei reduced the levels of IL-6,IL-1 β and TNF-α(P＜0.01)and increased that of IL-10(P＜0.05)in the hippocampus and peripheral blood,and decreased mRNA level of IDO1 and enhanced 5-HT mRNA level in hippocampus(P＜0.01)in the offspring rats of the MS+L.casei group.Conclusion MS stress induces depression-like behavior in offspring rats.L.casei inhibits the hippocampal expression of IDO1 and enhances that of 5-HT by regulating inflammatory factors in hippocampus and peripheral blood,and thus,improves depression-like behavior.

Objectives:To understand the differences in clinical characteristics, treatment status, and prognosis between outpatient and inpatient heart failure patients in the real world.Methods:A prospective, multicenter registration study was conducted to select 972 outpatient or inpatient heart failure patients from 24 different regions and levels of hospitals in China from December 2012 to November 2014. Demographic and clinical data, as well as treatment status, were collected and followed up at 1 year. The difference in medication treatment status between baseline and 1-year follow-up was compared using McNemar paired χ 2 test. Pearson χ 2 test was used to compare the differences in clinical data, treatment status, and outcomes between outpatient and inpatient patients. Results:There were 610 outpatient patients (62.8%), and the proportion of outpatient patients under 65 years old was higher than that of hospitalized patients [44.9%(274/610) vs 35.1%(127/362), P<0.05]. The proportion of NYHA grade Ⅲ/Ⅳ patients was as high as 50.8%(310/610), and 92.5%(564/610) of outpatient patients had difficulty breathing while walking uphill. 27.9%(170/610) of outpatient patients had jugular vein pressure greater than 6 cmH 2O, and 24.3%(148/610) of outpatient patients had pulmonary moist rales. There was no significant difference in the main causes of heart failure between outpatient and inpatient patients ( P=0.063), with ischemic cardiomyopathy being the main cause. At baseline, the use of beta blockers in outpatient patients was higher than that in hospitalized patients [63.0%(384/610) vs 54.4%(197/362), P<0.05], while the use of diuretics and aldosterone receptor antagonists was lower than that in hospitalized patients [53.1%(324/610) vs 72.1%(261/362), 49.5%(302/610) vs 61.3%(222/362), P<0.05]. There was no statistically significant difference in the use of ACEI/ARB between the two groups [67.4%(411/610) vs 62.4%(226/362), P>0.05]. At one-year follow-up, the use of ACEI/ARB in outpatient patients decreased [63.5%(360/567) vs 67.4%(411/610), P<0.05], the usage rate of aldosterone receptor antagonists in hospitalized patients decreased by [50.3%(165/328) vs 61.3%(222/362), P<0.05]. The one-year all-cause mortality rate of the two groups of patients was close to [6.7%(41/610) vs 9.4%(34/362), P=0.124], The hospitalization rate for heart failure in the outpatient group was lower than that of hospitalized patients [25.4%(155/610) vs 36.5%(132/362), P<0.05], but still>25.0%. Conclusions:Outpatient heart failure patients still have obvious symptoms and signs, and the prognosis is poor. The standardized management of outpatient heart failure patients cannot be ignored.

Objective:To investigate the application of virtual simulation-based teaching-examination linkage mode based on aneSIM anesthesia simulation system and NW13 difficult airway management model in improving the ability of anesthesia crisis resource management among trainees receiving standardized residency training.Methods:A total of 236 trainees (189 trainees with non-anesthesia majors and 47 with anesthesia majors) who received standardized residency training in Department of Anesthesiology in 2021 were selected as control group, and 234 resident trainees (184 trainees with non-anesthesia majors and 50 with anesthesia majors) in 2022 were selected as observation group. The trainees in the control group received traditional theoretical teaching, and those in the observation group received teaching with the aneSIM system. The trainees in both groups received two sessions of online theoretical assessment through the QR code in Bangboss Application, as well as situational simulation training and assessment using the NW13 difficult airway management model. SPSS 26.0 was used to perform the t-test and the chi-square test. Results:Compared with the control group, the observation group had a significantly higher score of the second theoretical assessment, significantly better degree of anxiety and score of simulation assessment, and significantly better knowledge mastery and ability improvement ( t=7.15, 14.31, 3.90, 6.22, 4.23, 3.04, all P<0.05). Compared with the control group in terms of the resident trainees with non-anesthesia majors, the observation group had a significantly higher score of the second theoretical assessment, significantly better degree of anxiety and score of simulation assessment, a significantly higher degree of satisfaction with teaching, and significantly better knowledge mastery and ability improvement ( t=7.77, 5.43, 3.09, 5.26, 3.82, 2.19, all P<0.05). Compared with the control group in terms of the resident trainees with anesthesia majors, the observation group had a significantly higher score of simulation assessment, a significantly higher degree of satisfaction with teaching, and significantly better knowledge mastery and ability improvement ( t=2.60, 3.56, 2.01, 2.48, P=0.011, 0.001, 0.047, 0.015). Conclusions:The mode of virtual simulation-based teaching-examination linkage based on the aneSIM anesthesia simulation system and NW13 difficult airway management model can examine and improve the abilities for difficult airway management and operation among resident trainees, especially those with non-anesthesia majors, thereby showing its application value in the teaching of anesthesia crisis resource management.

Objective:To investigate the application of virtual simulation-based teaching-examination linkage mode based on aneSIM anesthesia simulation system and NW13 difficult airway management model in improving the ability of anesthesia crisis resource management among trainees receiving standardized residency training.Methods:A total of 236 trainees (189 trainees with non-anesthesia majors and 47 with anesthesia majors) who received standardized residency training in Department of Anesthesiology in 2021 were selected as control group, and 234 resident trainees (184 trainees with non-anesthesia majors and 50 with anesthesia majors) in 2022 were selected as observation group. The trainees in the control group received traditional theoretical teaching, and those in the observation group received teaching with the aneSIM system. The trainees in both groups received two sessions of online theoretical assessment through the QR code in Bangboss Application, as well as situational simulation training and assessment using the NW13 difficult airway management model. SPSS 26.0 was used to perform the t-test and the chi-square test. Results:Compared with the control group, the observation group had a significantly higher score of the second theoretical assessment, significantly better degree of anxiety and score of simulation assessment, and significantly better knowledge mastery and ability improvement ( t=7.15, 14.31, 3.90, 6.22, 4.23, 3.04, all P<0.05). Compared with the control group in terms of the resident trainees with non-anesthesia majors, the observation group had a significantly higher score of the second theoretical assessment, significantly better degree of anxiety and score of simulation assessment, a significantly higher degree of satisfaction with teaching, and significantly better knowledge mastery and ability improvement ( t=7.77, 5.43, 3.09, 5.26, 3.82, 2.19, all P<0.05). Compared with the control group in terms of the resident trainees with anesthesia majors, the observation group had a significantly higher score of simulation assessment, a significantly higher degree of satisfaction with teaching, and significantly better knowledge mastery and ability improvement ( t=2.60, 3.56, 2.01, 2.48, P=0.011, 0.001, 0.047, 0.015). Conclusions:The mode of virtual simulation-based teaching-examination linkage based on the aneSIM anesthesia simulation system and NW13 difficult airway management model can examine and improve the abilities for difficult airway management and operation among resident trainees, especially those with non-anesthesia majors, thereby showing its application value in the teaching of anesthesia crisis resource management.