Application of capsulorhexis-chop forceps assisted prechop technique in hard cataract phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the advantages of capsulorhexis-chop forceps assisted prechop(CCFP)technique in hard cataract phacoemulsification.METHODS: Prospective study. A total of 100 cases(100 eyes)with age-related grade IV hard cataract were included and randomly divided into 2 groups according to random number table, with 50 patients(50 eyes)in CCFP technique group(group A)and 50 cases(50 eyes)in stop-and-chop technique group(group B). The corneal endothelial cell count before and after operation, intraoperative US time, postoperative corneal endothelial cell loss rate, corneal edema grade at 1 and 7d and best corrected visual acuity(BCVA)were compared and statistically analyzed.RESULTS: The mean US time of group A was lower than that of group B [26.66(16, 40)s vs. 36.12(23, 46)s; Z=-5.56, P<0.01]. The mean corneal endothelial cell count in group A was higher than that in group B at 3mo after operation(2308.12±368.18cell/mm2 vs. 2104.06±379.87cell/mm2; t=2.728, P=0.008), and the loss rate of corneal endothelial cells in group A was lower than that in group B at 3mo after operation [10%(8%, 12%)vs. 17%(14%, 20%); Z=13.231, P<0.01]. The number of eyes with corneal edema of grade 0, 1, 2, 3 and 4 on 1d after surgery was 0, 23, 21, 6 and 0 in group A, respectively, while it was 0, 9, 26, 15 and 0 respectively in group B. Corneal edema in group A was less than that in group B(Z=10.514, P=0.005). The BCVA of group A was better than that of group B at 1d after operation, and there was significant difference in the number of eyes with different BCVA grades between the two groups(Z=7.176, P=0.029). There was no significant difference in the number of eyes with different grades of BCVA between the two groups at 3mo after surgery(Z=2.377, P=0.372).CONCLUSION: Compared with the stop-and-chop technique, CCFP technique uses less ultrasonic energy, has less damage to corneal endothelial cells and is suitable for hard cataract surgery.

Application of the flipped classroom combined with 3D Body anatomy software in ultrasound-guided thoracic paravertebral block training / 中华医学教育探索杂志

Ultrasound-guided thoracic nerve block plays an important role in anesthesia and analgesia, but it is not easy to be mastered. This article discusses the application value of flipped classroom combined with 3D Body anatomy software for anesthesia specialty residents to learn ultrasound-guided thoracic paravertebral nerve block. This innovative education model includes three parts: before class, during class and after class. Before class, the teachers study the syllabus and make teaching micro-videos, and the cross-sectional anatomy added into the 3D Body anatomy software helps the residents understand. During class, teachers divide the residents into groups to report and exchange their learning experience, organize discussions, and finally give them comments. After class, the instructor will assign homework, assess the residents, and evaluate their satisfaction. This teaching model helps residents master the ultrasound-guided thoracic nerve block, and obtains satisfactory evaluation from the trainees, which is helpful for promotion.

Comparison of press-and-chop and Nagahara phaco-chop phacoemulsification nucleotomy techniques / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To discuss the advantages of press-and-chop technique compared with Nagahara phaco-chop technique.<p>METHORDS: Totally 70 patients(70 eyes)with age-related cataract were randomly divided into 2 groups, press-and-chop technique group(35 patients 35 eyes), phaco-chop technique group(35 patients 35 eyes). In all cases, surgery began with a clear corneal incision, capsulorhexis and hydrodissection. In the press-and-chop technique group, the superficial cortex and epinucleus were aspirated by the phaco tip, then press the center of the lens front surface with the phaco tip. The Nagahara chopper was set around the lens equator, then the phaco tip was driven into the nucleus from the main incision, pull the Nagahara chopper toward the phaco tip. The two instruments were then separated laterally to produce a complete fracture of the nucleus. In phaco-chop technique group, the phaco tip was buried in the center of the endonucleus. The Nagahara chopper was brought through the side-port incision and the equator of endonucleus was engaged by the chopper under the lower edge of the capsulorhexis and pulled toward the phaco tip. The 2 instruments were then separated laterally to produce a complete fracture of the nucleus. The U/S time, preoperative and postoperative corneal endothelial cell density, corneal endothelium loss rate, corneal edema at 1d, 7d, best corrected visual acuity before and after surgery were recorded.<p>RESULTS: The U/S time of press-and-chop technique group was lower than phaco-chop technique group [12.76(8.76,16.76)s <i>vs</i> 22.87(18.36, 27.38)s, <i>P</i><0.01]. The corneal endothelial cells density in press and chop technique group was higher than that in phaco-chop technique group 1mo after operation(2133.44±348.58/mm² <i>vs</i> 1957.94±280.54/mm², <i>P</i><0.05), and the variation rate of corneal endothelial cells in press-and-chop technique group was lower than that in phaco-chop technique group 1mo after surgery [0.15(0.08,0.22)<i>vs</i> 0.22(0.16, 0.28), <i>P</i><0.01]. The corneal edema in press-and-chop technique group was lighter than that in phaco-chop technique group on the first day after surgery(<i>Z</i>=13.195, <i>P</i>=0.004), and corneal edema in both groups subsided on the 7d after surgery. There was no significant difference between two groups in BCVA on the first day after surgery(<i>Z</i>=-0.48, <i>P</i>=0.63).<p>CONCLUSION: Compared with Nagahara phaco-chop technique, press-and-chop technique is simple and safe with less complications.

Application of the extended focused assessment with sonography for trauma (EFAST) combined with Workshop in the training of anesthesiologist / 中华医学教育探索杂志

Case-oriented Workshop training mode is a professional training method which has been highly praised by anesthesiologists in recent years. It is of great significance to stimulate the participation of anesthesiologists and strengthen the application of the extended focused assessment with sonography for trauma (EFAST) in perioperative anesthesia management. The training of EFAST is divided into two stages: the first stage is about the relevant knowledge of EFAST and watching standardized operations on site, and the second stage is for each trainee to practice the operations under the guidance of the teacher until they can complete them independently. The EFAST adopts Workshop training mode, and the trainees can complete the target area scanning in about 90 seconds on average. It can maximize the training effectiveness and comprehensively improve the trainees' mastery of knowledge and skills in an all-round way. It is a training mode worthy of promotion in anesthesiology department.

Practice and discussion of tutorial system in standardized training of residents in the department of anesthesiology / 中华医学教育探索杂志

Residency training is an indispensable part in the standardized training system of residents. The anesthesiology department of Peking University Third hospital launched the tutorial system in this residency training project as an initial exploration. Our study explored the concrete way of implementation of the tutorial system in the residency training program, including clarifying selection of the tutor, teachers' responsibilities, requirements for the residency, training contents and ways. Preliminary practice shows that tutorial system can enhance responsibilities of teachers, sense of belong of residents, and the quality of training.

Comparison of two different anesthesia methods for the procedure for prolapse and hemorrhoids in elderly patients with anorectal diseases / 中华老年医学杂志

Objective@#To compare the anesthetic effects of subarachnoid anesthesia(SA)and epidural anesthesia(EA)for the procedure for prolapse and hemorrhoids(PPH)in elderly patients with benign anorectal diseases.@*Methods@#A retrospective analysis was conducted in 60 patients with benign anorectal diseases admitted to Peking University Third Hospital from March to August 2018 and undergoing PPH.According to anesthesia methods, patients were divided into the SA group and the EA group (n=30 each). The level of sensory block was tested by acupuncture, and the degree of motor block was assessed by revised Bromage score.The anesthesia effect, operation time, blood loss, adverse events and hospitalization time were compared between the two groups.@*Results@#The highest level of sensory block was similar between the two groups without significant difference(P>0.05). The median onset time of sensory block was longer in the EA group [270.0 s(interquartile range, 66.3 s)] than in the SA group [25.5 s(interquartile range, 14.3 s)]. The revised Bromage score was lower in the EA group than in the SA group [1.0(interquartile range, 1.0)vs.2.0 (interquartile range, 1.0), Z=6.657, -1.685, both P=0.000]. The risks of hypotension, nausea and vomiting, and urinary retention were lower in the EA group than in the SA group (χ2=6.405, 4.286 and 4.403, P=0.011, 0.038 and 0.044). There were no significant differences in anesthetic effect, operation time, blood loss and hospitalization time between the two groups(all P>0.05).@*Conclusions@#EA can provide a perfect anesthesia and analgesic effect for elderly patients receiving PPH, with the advantages of rapid recovery of limb movement and low adverse events.As a substitute for SA, EA is a suitable anesthesia method for promoting the enhanced recovery after surgery(ERAS)in patients with benign anorectal diseases.

Comparison of two different anesthesia methods for the procedure for prolapse and hemorrhoids in elderly patients with anorectal diseases / 中华老年医学杂志

Objective To compare the anesthetic effects of subarachnoid anesthesia(SA)and epidural anesthesia(EA)for the procedure for prolapse and hemorrhoids(PPH)in elderly patients with benign anorectal diseases.Methods A retrospective analysis was conducted in 60 patients with benign anorectal diseases admitted to Peking University Third Hospital from March to August 2018 and undergoing PPH.According to anesthesia methods,patients were divided into the SA group and the EA group (n=30 each).The level of sensory block was tested by acupuncture,and the degree of motor block was assessed by revised Bromage score.The anesthesia effect,operation time,blood loss,adverse events and hospitalization time were compared between the two groups.Results The highest level of sensory block was similar between the two groups without significant difference(P ＞0.05).The median onset time of sensory block was longer in the EA group [270.0 s(interquartile range,66.3 s)] than in the SA group [25.5 s(interquartile range,14.3 s)].The revised Bromage score was lower in the EA group than in the SA group [1.0(interquartile range,1.0)vs.2.0 (interquartile range,1.0),Z =6.657,-1.685,both P =0.000].The risks of hypotension,nausea and vomiting,and urinary retention were lower in the EA group than in the SA group (x2 =6.405,4.286 and 4.403,P=0.011,0.038 and 0.044).There were no significant differences in anesthetic effect,operation time,blood loss and hospitalization time between the two groups (all P ＞ 0.05).Conclusions EA can provide a perfect anesthesia and analgesic effect for elderly patients receiving PPH,with the advantages of rapid recovery of limb movement and low adverse events.As a substitute for SA,EA is a suitable anesthesia method for promoting the enhanced recovery after surgery(ERAS) in patients with benign anorectal diseases.

Interpretation of expert ideas in the 6st World Symposium on Pulmonary Hypertension（Ⅲ）——risk stratification of and drug treatment for pulmonary arterial hypertension / 中国实用内科杂志

Pulmonary arterial hypertension(PAH)remains a severe clinical condition despite the increasing understanding of PAH, the publication of many randomized controlled studies, and the availability of multiple targeted drugs over the past 20 years. Risk stratification of PAH can predict prognosis and guide treatment. The new risk stratification criterion,which combines clinical, exercise, right ventricular function and hemodynamic parameters, has good consistency with the original criteria,and its clinical practicability has increased significantly. Appropriate initial treatment strategies are established based on the risk stratification of newly diagnosed PAH patients. The risk stratification of patients is continuously evaluated during follow-up, and possible deterioration is detected in time. Then the treatment plan can be adjusted to improve the prognosis of patients.

Clinical features of patients with pulmonary thromboembolism complicated by hemoptysis and the prognosis analysis during hospital stay / 中国实用内科杂志

OBJECTIVE: To analyze the clinical feature and prognosis during hospitalization of pulmonary thromboembolism(PTE) patients with hemoptysis. METHODS: Between January 2010 and January 2015, a total of 220 patients diagnosed with acute PTE were recruited in our study in Beijing Hospital. Baseline characteristics, clinical signs and symptoms, laboratory tests, imaging findings, therapy and hospitalization outcomes(including mortality, and incidences of bleeding events) were collected. All the patients were divided into two groups according to whether hemoptysis occurred. A variety of clinical parameters in clinical features and prognosis were compared between the two groups.RESULTS: Among 220 patients, 16(7.3%) had hemoptysis and 204(92.7%) did not. Hemoptysis group were significantly younger [(59.7±16.6)vs.(67.2±13.6) years, P=0.037] and there were more males(75.0% vs. 44.6%, P=0.034). Compared to patients without hemoptysis, those with hemoptysis had a higher incidence of fever(31.3% vs. 11.3%, P=0.037) and chest pain(50.0% vs. 26.0%; P=0.039). The average diagnosis time of hemoptysis group was(8.91 ± 6.09) days. Patients in the hemoptysis group had a higher proportion of inferior vena cava filter(IVCF)(18.8%vs. 3.4%, P=0.028). There was no significant difference in severity and in-hospital mortality between the two groups. CONCLUSION: The lack of specificity of hemoptysis caused by PTE often leads to misdiagnosis or delayed diagnosis. Early diagnosis is helpful to correct treatment and reduce the adverse consequences of improper measures.

Pepstatin Pr show anti-fibrosis effect related to YAP-TGFβ-Smad pathway / 药学学报

Liver fibrosis is a tissue repair compensatory response to liver injury caused by various chronic factors, ultimately leading to liver cirrhosis, liver failure and even hepatocellular carcinoma. Abnormal activation of hepatic stellate cells is the cellular basis of liver fibrosis development. Pepstatin Pr, the derivative of pepstatin A, was isolated from Streptomyces sp. CPCC 202950. Our purpose was to investigate the anti-fibrotic activity of pepstatin Pr and explore its molecular mechanism. Hepatic stellate cell LX-2 was stimulated by TGFβ1 and sub- sequently treated with pepstatin Pr. Its cytotoxicity was detected by sulforhodamine B (SRB) assay. The expression of COL1A1, α-SMA and cathepsin D, signaling proteins TGFβ, Smad and YAP/TAZ were detected by Western blot or real-time PCR. The results showed that pepstatin Pr was not cytotoxic to LX-2 cells. And pepstatin Pr significantly reduced the mRNA and protein expression of COL1A1 and α-SMA, which are important liver fibrosis markers. Pepstatin Pr also repressed the protein expression level of cathepsin D, TGFβ1, YAP/TAZ, the phospholation level of Smad2, and YAP nuclear translocation. In conclusion, pepstatin Pr exhibits anti-fibrotic effects in TGFβ1-stimulaed LX-2 cells by mediating YAP-TGFβ-Smad pathway.

Anesthesia management of cervical chordoma resection: A case report / 北京大学学报(医学版)

Chordoma is a slow-growing, locally invasive, lowgrade malignant tumor with a prevalence of one in 100 000, accounting for 1%-4% of all malignant bone tumors. At present, it is considered that chordoma originates from ectopic embryonic chordal tissue and can occur in any part of the spine from the skull base to the sacrum. About 50% of chordoma occurs in the sacrococcygeal region, about 30% in the skull base, and the rest occurs in the active spinal region. Cervical chordoma is rare, but it may be accompanied by difficult airways. The tumors compress the pharynx and throat forward, which can cause upper airway obstruction. If the anesthesia is not properly handled, the patient may die of asphyxia. The core issues of airway management during the perioperative period of cervical chordoma surgery involve three main parts: preoperative airway evaluation, airway management and extubation management. Difficult airway assessment often relies on physical examination indicators, such as inter-incisor gap, thyromental distance, neck circumference, Mallampati test, etc. But the accuracy is insufficient. The application of imaging examination in the observation of different tissues can make up for the inaccurate evaluation of the internal structure of the airway. Because chordoma destroys cervical vertebral body and accessories, cervical stability is impaired. Excessive cervical vertebral extention should be avoided during tracheal intubation to prevent severe compression of the spinal cord. It is better to fix the head by an assistant and perform neutral tracheal intubation. Considering that the patient with a difficult airway that could be predicted before operation, the strategy of tracheal intubation under conscious sedation with topical anesthesia was selected. After sedation and topical anesthesia, the patient was successfully intubated with optical stylet. After operation, the patient returned to ICU with tracheal catheter. On the 4th day after operation, the tracheal tube was pulled out. On the 5th day after operation, the patient was transferred to the orthopaedic ward and discharged on the 7th day after operation. It is of great significance to establish specific strategies for such operations to reduce related complications, speed up post-operative rehabilitation and save medical resources. We reported the anesthetic management of cervical chordoma cured in Peking University Third Hospital.

C5-6 nerve root block technique for postoperative analgesia of shoulder arthroscope: a randomized controlled trial / 北京大学学报(医学版)

OBJECTIVE@#To compare the effects of ultrasound-guided interscalene brachial plexus block and C5-6 nerve root block for analgesia after shoulder arthroscopy.@*METHODS@#In the study, 40 patients of ASA I-II were selected for elective general anesthesia to repair the shoulder ligament rupture in Peking University Third Hospital, who were randomly divided into two groups, respectively for the intermuscular brachial plexus block group (group I) and C5-6 nerve root block group (group C), n=20. The forty patients underwent ultrasound-guided brachial plexus block or C5-6 nerve root block before general anesthesia. Group I: 0.2% ropivacaine 10 mL was injected into brachial plexus intermuscular approach; Group C: 0.2% ropivacaine 10 mL was injected around the nerve roots of C5 and C6, and the ultrasound images showed that the liquid wrapped nerve roots. The time of sensory and motor block after puncture, operation time, the time of postoperative analgesia, numerical rating scale (NRS) scores at 1, 6, 12, and 24 h postoperatively and the finger movements were recorded. The adverse drug reactions and the patient satisfaction were recorded. The primary end point was the study of shoulder rest and movement pain in the patients with postoperative nerve blockage; the secondary end point was the patient's limb movements and thepatient satisfaction.@*RESULTS@#The duration of analgesia was (571.50±70.11) min in group I and (615.60±112.15) min in group C, and there was no difference between the two groups (P>0.05). The static and dynamic NRS scores at 1, 6, and 12 h in group C were lower than those in group I (P<0.05). There was no difference in static and dynamic NRS scores between the two groups during 24 hours (P>0.05). There was a significant difference in grade of muscle strength between group C [5(4,5)] and group I [4(2,4)] in the patients with nerve block hind limb (P<0.01), and there were significant differences between the two groups' sensation in the radial nerve group C [1(0,2)] and group I [2(1,2)], the median nerve group C [0(0,2)] and group I [2(1,2)], and the ulnar nerves group C [0(0,1)] and group I [1(1,2)] (P<0.01). There was no statistical difference between the two groups in the sencation of the shoulder, group C 2(1,2) and group I 2(1,2) , P>0.05. Compared with group I 8(6,9), group C 9(8,10) was a significant difference in satisfaction (P<0.01).@*CONCLUSION@#Interscalene brachial plexus block and C5-6 nerve root block could satisfy the needs of analgesia after shoulder arthroscopy, but C5-6 nerve root blockage does not limit the limb activity, the numbness is less, and the patient's satisfaction is higher.

Comparison of combined spinal-epidural anesthesia versus lumbar plexus-sciatic nerve block in elderly patients undergoing internal fixation of hip fractures / 中华麻醉学杂志

Objective To compare combined spinal-epidural anesthesia (CSEA) versus lumbar plexus-sciatic nerve block (LPSB) in elderly patients undergoing internal fixation of hip fractures.Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ elderly patients,aged 66-94 yr,with body mass index of 15.2-28.0 kg/m2,scheduled for internal fixation of hip fractures,were randomly assigned into CSEA group and LPSB group using SPSS 18.0 software,with 30 patients in each group.In CSEA group,intrathecal catheter was successfully placed at L3,4 interspace,0.5％ hyperbaric bupivacaine 8-10 mg was injected into the subarachnoid space and then an epidural catheter was placed.In LPSB group,posterior lumbar plexus block was performed with 0.4％ ropivacaine 25-30 ml and parasacral sciatic nerve block with 0.4％ ropivacaine 15-20 ml.Dexmedetomidine 0.4-0.6 μg · kg-1 · h-1 was infused during the procedure to maintain the Observer's Assessment of Alertness/Sedation Scale score of 3 or 4 in two groups.Patient-controlled intravenous analgesia was performed with sufentanil and lasted for 48 h.The anesthesia time,volume of intraoperative fluid infused,blood loss,consumption of dexmedetomidine,requirement for vasoactive agents,cardiovascular events,consumption of sufentanil within 24 and 48 h after surgery,rescue analgesia and postoperative adverse reactions were recorded.Results Compared with CSEA group,the anesthesia time was significantly prolonged,the volume of intraoperative fluid infused and consumption of ephedrine were reduced,the consumption of dexmedetomidine was increased,the incidence of bradycardia was decreased,the postoperative consumption of sufentanil was reduced,the rescue analgesia rate was decreased,and no significant change was found in the incidence of postoperative adverse events in LPSB group (P＞0.05).Conclusion LPSB can maintain hemodynamics stable and provide postoperative analgesic effect,with better anesthetic efficacy than CSEA when used for internal fixation of hip fractures in elderly patients.

Analysis on risk factors of postoperative cardiovascular complications in the elderly patients with hip fracture / 临床麻醉学杂志

Objective To investigate the risk factors of postoperative cardiovascular complica-tions in elderly patients with hip fracture during hospitalization.Methods A retrospective analysis was conducted according to the medical records of 693 elderly patients with hip fracture admitted to our hospital from January,2005 to December,2015.There were 257 males and 436 females,aged 65-103 years and body mass index (BMI)16.5-33.1 kg/m2,ASA physical status Ⅱ-Ⅳ.The demo-graphic data,preoperative comorbidities,time before surgery,surgical types,anesthetic methods, operation time and blood loss were recorded.Multivariate logistic regression analysis was applied to analyze the risk factors of postoperative cardiovascular complications in elderly patients with hip frac-ture during hospitalization.Results Postoperative cardiovascular complications occurred in 46 (46/693,morbidity:6.64%),including angina pectoris,arrhythmia,heart failure,myocardial infarction and sudden cardiac death.Univariate analysis showed that the independent variables of postoperative cardiovascular complications were age,cardiac comorbidities,hypertention,diabetes mellitus,cere-brovascular disease,renal insufficiency and anesthetic methods (P < 0.05).Multiple logistic regression analysis showed that age(OR=1.11,95% CI 1.06-1.17,P<0.001),cardiac comorbidi-ties (OR=1.98,95% CI 1.02-3.85,P=0.045),hypertention(OR=2.61,95% CI 1.23-5.51,P=0.012),diabetes mellitus (OR=2.06,95% CI 1.04-4.09,P=0.039),cerebrovascular disease (OR=2.14,95% CI 1.06-4.32,P=0.033)and renal insufficiency (OR=17.42,95% CI 3.69-82.80,P<0.001)were independent risk factors for postoperative cardiovascular complications in elderly patients with hip fracture during hospitalization.Conclusion Age,cardiac comorbidities,hy-pertention,diabetes mellitus,cerebrovascular disease and renal insufficiency are independent predictors for postoperative cardiovascular complications in elderly patients with hip fracture during hospitalization.

Effect of different anesthetic methods on postoperative outcomes in elderly patients undergoing hip fracture surgery / 北京大学学报(医学版)

Objective:To investigate the effect of general or regional anesthesia on postoperative cardiopulmonary complications and inpatient mortality after hip fracture surgery in elderly patients.Methods:A retrospective analysis was conducted according to the medical records of 572 elderly patients with hip fractures admitted to our hospital from January 1,2005 to December 31,2014.The age,gender,preoperative comorbidities,length of preoperative bedridden time,mechanism of injury,surgical types,anesthetic methods,major postoperative complications and inpatient mortality were recorded.Multivariate Logistic regression analysis was applied to analyze the impact of different anesthetic methods on inpatient mortality in these patients.Results:Of the 572 patients,392 (68.5％) received regional anesthesia.Inpatient death occurred in 8 (8/572,mortality:1.4％),including 5 cases of RA group (5/392,mortality:1.3％) and 3 cases of GA group (3/180,mortality:1.7％).There was no statistically significant difference between the two groups in inpatient mortality (P ＞ 0.05).Multiple Logistic regression analysis showed that gender (odds ratio:0.18,95％ CI:0.03-1.05,P =0.057),age (odds ratio:1.22,95％ CI:1.07-1.38,P =0.002),preoperative pulmonary comorbidities (odds ratio:12.09,95％ CI:2.28-64.12,P =0.003) and surgical types (odds ratio:9.36,95％ CI:1.34-64.26,P =0.024) were risk factors for inpatient mortality.Postoperative cardiovascular complications occurred in 36 patients (36/572,morbidity:6.3％),with 19 patients in RA group (19/392,morbidity:4.8％),and 17 patients in GA group (17/180,morbidity:9.4％).Multiple Logistic regression analysis showed that age (odds ratio:1.13,95％ CI:1.07-1.19,P ＜ 0.001),hypertension (odds ratio:2.72,95％ CI:1.24-5.96,P =0.012) and preoperative cerebral comorbidities (odds ratio:2.11,95％ CI:0.99-4.52,P =0.054) were risk factors for postoperative cardiovascular complications.Postoperative pulmonary complications occurred in 56 patients (56/572,morbidity:9.8％),with 19 patients in RA group (19/392,morbidity:4.8％),and 37 patients in GA group (37/180,morbidity:20.6％).Multiple Logistic regression analysis showed that age (odds ratio:1.13,95％ CI:1.07-1.19,P ＜0.001),preoperative pulmonary comorbidities (odds ratio:2.89,95％ CI:1.28-7.05,P=0.020),length of preoperative bedridden time (odds ratio:1.11,95％ CI:1.04-1.18,P =0.003) and anesthetic methods (odds ratio:5.86,95％ CI:2.98-11.53,P ＜ 0.001) were risk factors for postoperative pulmonary complications.Conclusion:General anesthesia may not affect the inpatient mortality after hip fracture surgery in elderly patients.Regional anesthesia is associated with a lower risk of pulmonary complications after surgical procedure compared with general anesthesia.

A study of the effect of mannequin training on management of unanticipated difficult airway / 中华医学教育探索杂志

Objective This study on a medium-fidelity simulator (SimMan , Laerdal Medical Corpo-ration,Wappingers Falls, NY, USA) examined the management of unanticipated difficult airway by residents of anesthesiology and the effect of training in this context.Methods 30 residents of anesthesiology were devided into two groups (T and E). There were two scenarios investigated:'can't intubate, can oxygenate'(CI) and'can't intubate, can't oxygenate'(CICO). The E group was trained by scene simulation in the second, fourth, sixth month respectively before and after the training, and the T group received the same situation simulation training on the same day after the theoretical training and in the second, sixth month after the training. In con-trast to standard operating procedures, the performance of two groups of trainees was recorded on the basis of pre established evaluation criteria. Data differences between the two groups were analyzed using SPSS 23.0,t test, M-W test andx2 test.ResultIn CI, success rate of placement of astandard and intubating laryngeal mask air-way were high in T group (87％ vs. 55％ ,P=0.037). This was sustained over time. There was no difference in duration and incidence of desaturation between two groups. In CICO, there was a more structured approach following training in T group (P<0.05), which wasn't sustained over time. But this was sustained over 6 months in E group.ConclusionSituational simulation training can significantly improve the anesthesiology residents' ability to take proper response measures to the unexpected difficult airway, and significantly shorten the training time for emergency airway treatment. Repeated situational simulation training should be conducted at intervals of 2 months or less, allowing residents to maintain emergency response to the emergency airway.

Advances in studies of ileal apical sodium-dependent bile acid transporter / 药学学报

Bile acids play critical roles in the regulation of metabolism and absorption of lipids. The ileal apical sodium-dependent bile acid transporter (ASBT) located at the enterocyte brush border is responsible for the reuptake of bile acids and the maintenance of bile acid homeostasis. Recently, a number of investigations have been made concerning the regulation and control of ASBT and the relationship between ASBT and intestinal inflammation, tumorigenesis, diabetes mellitus and hyperlipemia, which suggests ASBT as a potential therapeutic target of these diseases. In this review, advances in the study of above-mentioned issues were summarized.

Shikani Optical Stylet versus Macintosh Laryngoscope for Intubation in Patients Undergoing Surgery for Cervical Spondylosis: A Randomized Controlled Trial / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Airway management is critical in patients with cervical spondylosis, a population with a high incidence of difficult airway. Intubation with Shikani Optical Stylet (SOS) has become increasingly popular in difficult airway. We compared the effects of intubation with SOS versus Macintosh laryngoscope (MLS) in patients undergoing surgery for cervical spondylosis.</p><p><b>METHODS</b>A total of 270 patients scheduled for elective surgery for cervical spondylosis of spinal cord and nerve root type from August 2012 to January 2016 were enrolled and randomly allocated to the MLS or SOS group by random numbers. Patients were evaluated for difficult airway preoperatively, and Cormack-Lehane laryngoscopy classification was determined during anesthesia induction. Difficult airway was defined as Cormack-Lehane Grades III-IV. Patients were intubated with the randomly assigned intubation device. The success rate, intubation time, required assistance, immediate complications, and postoperative complaints were recorded. Categorical variables were analyzed by Chi-square test, and continuous variables were analyzed by independent samples t-test or rank sum test.</p><p><b>RESULTS</b>The success rate of intubation among normal airways was 100% in both groups. In patients with difficult airway, the success rates in the MLS and SOS groups were 84.2% and 94.1%, respectively (P = 0.605). Intubation with SOS took longer compared with MLS (normal airway: 25.1 ± 5.8 s vs. 24.5 ± 5.7 s, P = 0.426; difficult airway: 38.5 ± 8.5 s vs. 36.1 ± 8.2 s, P = 0.389). Intubation with SOS required less assistance in patients with difficult airway (5.9% vs. 100%, P< 0.001). The frequency of postoperative sore throat was lower in SOS group versus MLS group in patients with normal airway (22.0% vs. 34.5%, P = 0.034).</p><p><b>CONCLUSIONS</b>SOS is a safe and effective airway management device in patients undergoing surgery for cervical spondylosis. Compared with MLS, SOS appears clinically beneficial for intubation, especially in patients with difficult airway.</p><p><b>TRIAL REGISTRATION</b>Chinese Clinical Trial Registry, ChiCTR-IOR-16007821; http://www.chictr.org.cn/showproj.aspx?proj=13203.</p>

Application of Protective Lung Ventilation During General Anesthesia / 中国微创外科杂志

ventilation mode selection , which can reduce the incidence of postoperative pulmonary complications and improve patient ’ s outcomes . This paper reviewed and summarized the application of protective lung ventilation during general anesthesia .

Progress on Ultrasound-guided Thoracic Paravertebral Block / 中国微创外科杂志

[Summary] Thoracic paravertebral block ( TPVB) can offer intra-postoperative analgesia for thoracic , cardiac, and breast operations .In recent years , the development of ultrasonic technology provides a platform for real-time and visual never block , which can further improve the success rate and reduce the incidence of complications .In this article, we reviewed the various approaches of ultrasound guidance for thoracic paravertebral blockade , and explored the latest progress of different technologies .