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 explore the diagnosis and treatment of posterior shoulder dislocation combined with reverse Hill-Sachs lesion.Methods:Two male patients were treated at Department of Joint Surgery, Affiliated Hospital of Qingdao University for posterior shoulder dislocation combined with reverse Hill-Sachs lesion from August to November 2022. Case 1 was a 46-year-old man, admitted 1 day after right should injury, and case 2 a 57-year-old man, admitted 2 days after right should injury. The injury was caused by electric shock in both, and their fractures were fresh with an injury area>50%. After anatomical reduction of the collapsed humeral head via the pectoralis major deltoid approach, an artificial bone was implanted and fixated with countersunk screws in both cases to reduce the shoulder joint. The Constant-Murley scale and visual analogue scale (VAS) were used to evaluate the functional recovery of the shoulder and pain after treatment.Results:No such perioperative complications as incision infection, brachial plexus injury or vascular injury was observed in either of the 2 patients. Reexamination 3 months after surgery showed in case 1: 110° of shoulder anterior flexion, 90° of shoulder abduction, 30° of external rotation (neutral position), 70° of internal rotation (neutral position), 70 points of Constant-Murley shoulder score, and 3 points of VAS pain score; in case 2: 130° of shoulder anterior flexion, 120° of shoulder abduction, 50° of external rotation (neutral position), 80° of internal rotation (neutral position), 70 points of Constant-Murley shoulder score, and 2 points of VAS pain score.Conclusion:For patients with posterior shoulder dislocation complicated with reverse Hill-Sachs lesion and humeral head collapse greater than 50%, open reduction and screw internal fixation combined with artificial bone grafting can achieve good short-term curative efficacy.

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 evaluate the feasibility of the BioPerfectus multiplex real time (BMRT) HPV assay for self-sample cervical cancer screening. Methods Eight hundreds and thirty-nine self-collected and physician-obtained DNA samples from the Shenzhen cervical cancer screening trialⅣ(SHENCCAST-Ⅳ) study collected samples for cervical cancer screening during June 2013 to September 2014 were detected by BMRT HPV assay to evaluate the screening efficacy. Results A total of the 839 women who were screened, 804 with complete BMRT HPV data was included in the study, and average age was (46±7) years. Of the 804 women, the positive rates of 14 high-risk HPV genotypes (including HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66 subtype) of self-sample and physician-obtained samples were 12.2% (98/804) and 12.8% (103/804), respectively (χ2=0.14, P=0.71). Self-collected samples with HPV-positive had significantly more cells (median 19 901.0) than physician-obtained samples (median 1 778.4), and there was statistically significant difference (Z=-7.61, P<0.01). The degree of agreement between self-sample and physician-obtained samples of HPV 16, HPV 18 and other 12 high risk HPV genotype was 99.8%, 100.0% and 96.1%, respectively. And the consistent Kappa value was 0.95,1.00 and 0.81, respectively. Of 804 samples, there were 6 cervical intraepithelial neoplasia (CIN)Ⅱ+cases. There were no missed CINⅡ+cases by BMRT HPV assay. Conclusion BMRT HPV assay is feasible for self-sample cervical cancer screening.

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

Objective To investigate the association between serum direct bilirubin (DBIL) with metabolic syndrome (MS) and its components.Methods A dynamic health check-up cohort study was set up from 2006 to 2011.5 258 participants who satisfied the two basic rules:1) being free of MS at the 1st health check-up program;2) having at least two intact health checks were included in this study.With generalized estimating equation (GEE) model,after adjusting for items as age,gender,smoking,drinking,alanine aminotransferase,aspartate aminotransferase,γ-glutamyltransferase,uric acid,blood urea nitrogen and white blood cells,the multivariable relative risks (RRs) of DBIL with MS and their components were analyzed.Results The RRs of DBIL for MS was 0.722 (95％ CI:0.654-0.797),which showing a dose-response.Serum DBIL was negatively associated with obesity and hyperlipidemia.Taking factors as gender and age into account,in the ＜45 years and 45-55 years groups,the RRs of DBIL for MS in females appeared as 0.516 (95％CI:0.349-0.761) and 0.435 (95％CI:0.256-0.740).And in males of ＜45 years and 45-55 years,the RRs of DBIL for MS were 0.738 (95％ CI:0.644-0.846) and 0.790 (95％ CI:0.667-0.937),respectively.Conclusions The elevated DBIL levels in serum appeared an early biomarker for MS and its components (obesity and hyperlipidemia).In particular,they may play a role in reducing the risk of MS in both females and males before 55 years of age.

Objective To evaluate the therapeutic effect of highly active anti-retroviral therapy (HAART) in treatment-na(i)ve Chinese patients with AIDS, to provide evidences for standardizing HAART.Methods Seventy-four treatment-naive AIDS patients were initiated with HAART and followed up regularly for 3 years. The clinical and laboratory data, side effects and drug resistance were observed and analyzed during the follow-up period. Results Of the 74 patients, 46 were males and 28 were females, with the average age being 42 years. The mean HIV viral load was ( 2. 2 ± 2.0 ) × 105 copies/ml and the baseline mean CD4+ T lymphocyte count was (62 ± 71 )cells/μl before treatment. After treatment for 3, 6, 12, 18,24, 30 and 36 months, the percentage of undetectable HIV viral road (less than 50 copies/ml ) was 71.6%, 83.8%, 75.7%, 77.0%, 82.4%, 81.1% and 79.7% respectively, and CD4+T lymphocyte count ascended to ( 167 ± 105), ( 177 ± 129), (238 ± 137), (290 ± 158), (304 ± 191 ), (331 ± 175) and ( 352 ± 202 ) cells/μl. The increase in amplitude of CD4+ T lymphocyte count in different periods examined was different, with the period of 0-3 months post-treatment demonstrating the most obvious augmentation ( P ＜ 0. 01 ) . The most common adverse reactions were liver function injury ( 52/74,70. 3% ), hyperlipemia (52/74, 70. 3%), hematopoietic inhibition of the bone marrow (33/74, 44. 6% ),peripheral neuritis (32/74, 43.2% ) and lipoatrophy (26/74, 35. 1%). Clinical drug resistance were found in nine patients and HIV gene mutations were detected in these patients. Conclusions Chinese treatment-naive AIDS patients have achieved good virological and immunological response to generic-drugpredominant HAART regimes with low drug resistance, but relatively more side effects.

Three cases of terminal stage heart disease received orthotopic heart transplantation at the Department of Cardiothoracic Surgery, the First Hospital of Nanchang University between August 2001 and December 2003. These three cases were all female and died of brain death. Body weight difference between donor and recipient was less than 20%. All three cases underwent superior and inferior vena cave osculation and received immunosuppressive therapy of cyclosporine A, prednisone, and mycophenolate postoperatively. They were successfully discarded. Heart function recovered to grade Ⅰ-Ⅱ(NYHA). No infection or serious rejection was found during the surgery. These results indicate that good donor heart preservation, consummate perioperative processing, and proper immunosuppressiva therapy are the key measures of successful heart transplantation.