Objective To study the effect of preoperative blood pressure control on postoperative cardiovascular events in patients with hypertension and gastrointestinal surgery. Methods A total of 238 hypertensive patients who underwent gastrointestinal surgery were selected and divided into control group (n =118)and non-control group (n =120)according to thehypotensor treatment.During the operation,the same anesthetic regimen was used.The use of vasoactive drugs was recorded during anesthesia.Bladder chalone C (Cys C)and cardiac troponin T (cTnT)were de-tected in blood before and after the operation,and so were N-terminal B type natriuretic peptide (NT-proBNP)level on the 1st and 5th day after the operation.The postoperative hospitalization time,fol-low-up of cardiovascular events 28 and 90 days after discharge were recorded.Results Compared with the non-control group,the total dosage of ephedrine in the control group was significantly re-duced [(3.41±1.04)mg vs (7.46 ± 3.29)mg,P <0.05 ],total dose of phenylephrinewas signifi-cantly reduced [(0.17±0.10)mg vs (0.46 ±0.16)mg,P <0.05],postoperative hospital stay was significantly shorter [(5.92±1.15)d vs (9.65±1.61)d,P <0.05],NT-proBNP level in the control group on the 1st day after the operation [(108.00 ± 47.11 )pg/L vs (250.38 ± 62.92 )pg/L,P <0.01]and 5 days after the operation [(62.07 ±25.31)pg/L vs (199.02 ± 60.32)pg/L,P <0.01 ] was obviously reduced.There was no statistical difference in Cys C andcTnT between the two group-safter operation.The incidence of cardiovascular adverse events in the control group was significantly lower than that in the non-control group (28 d:13.6% vs 62.7%,90 d:23.3% vs 23.3%,P <0.05).Conclusion Strict control of preoperative blood pressure control in patients with hypertension can significantly reduce the incidence of cardiovascular events.

Objective:To explore the research hotspots and development trends of the transformation of virtual skill training to practical clinical ability in current medical simulation education, and to conduct visual bibliometric analysis.Methods:Taking 783 pieces of literature related to the transformation of simulation skill training to clinical competence collected from the Web of Science core collection database from 2006 to 2020 as data sources, CiteSpace V was used for visualization processing and analysis, so as to reveal the transformation effect and future research direction.Results:The number of published papers and citations increased exponentially with each year. The United States and Canada were the main research forces, the University of Toronto Medical Center contributed the largest number of research, and Professor McGaghie of Northwestern University was the author with the most published articles. According to the literature co-citation cluster analysis, it is found that the transformation of simulation skill training includes both operation and non-operation skills. High-frequency cited references reflect the knowledge base of this field and research to a certain extent. Research frontiers include the improvement of virtual reality simulators, clinical outcomes of simulated training in pediatrics, nursing, and emergency disciplines, and the design of randomized controlled clinical trials.Conclusion:The research on the clinical effect verification of simulation skill training is developing rapidly in the world. The research on medical skills' transformation represented by minimal invasive surgery such as endoscopy is a hot topic. Non-operational skills including communication skills, teamwork, pediatric emergency skills, and virtual reality technology simulation effects are the research frontiers. The number of researches on the effect of simulation training is small and the effect is unclear. In the future, more randomized controlled studies are still needed to determine the effectiveness of the transformation of simulation training to clinical competence.

ObjectiveBased on ultra performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS^E） technique， we identified qualitatively the metabolites of aristolochic acid（AAs） in rat in order to analyze the metabolic differences between water extract of Aristolochiae fructus（AFE） and Aristolochic acid Ⅰ（AAⅠ）. MethodSD rats were selected and administered AFE（110 g·kg^-1·d^-1） or AAⅠ（5 mg·kg^-1·d^-1） by oral for 5 days， respectively. Serum， urine and feces were collected after administration. Through sample pretreatment， ACQUITY UPLC BEH C₁₈ column（2.1 mm×100 mm， 1.7 μm） was used with the mobile phase of 0.01% formic acid methanol（A）-0.01% formic acid water（B， containing 5 mmol·L^-1 ammonium acetate） for gradient elution（0-1 min， 10%B； 1-7 min， 10%-75%B； 7-7.2 min， 75%-95%B； 7.2-10.2 min， 95%B； 10.2-10.3 min， 95%-10%B； 10.3-12 min， 10%B） at a flow rate of 0.3 mL·min^-1. Positive ion mode of electrospray ionization（ESI⁺） was performed in the scanning range of m/z 100-1 200. In combination with UNIFI 1.9.4.053 system， the Pathway-MS^E was used to qualitatively analyze and identify the AAs prototype and related metabolites in biological samples（serum， urine and feces）， and to compare the similarities and differences of metabolites in rats in the subacute toxicity test between AFE group and AAⅠ group. ResultCompared with AAⅠ group， 6， 10， 13 common metabolites and 14， 20， 30 unique metabolites were identified in biological samples（serum， urine and feces） of AFE group， respectively. Moreover， the main AAs components always followed the metabolic processes of demethylation， nitrate reduction and conjugation. Compared with common metabolites in AAⅠ group， prototype components of AAⅠ in serum and most metabolic derivatives of AAⅠ［AAⅠa， aristolochic lactam Ⅰ（ALⅠ）a， 7-OHALⅠ and its conjugated derivatives］ in biological samples were significantly increased in AFE group（P<0.05， P<0.01）， except that the metabolic amount of ALⅠ in feces of AFE group was remarkably lowed than that of AAⅠ group（P<0.01）. In addition， a variety of special ALⅠ efflux derivatives were also identified in the urine and feces of the AFE group. ConclusionAlthough major AAs components in AFE all show similar metabolic rules as AAⅠ components in vivo， the coexistence of multiple AAs components in Aristolochiae Fructus may affect the metabolism of AAⅠ， and achieve the attenuating effect by increasing the metabolic effection of AAⅠ and ALⅠ.