The strategy of optimizing anesthetic management was carried out in all the patients un?dergoing thoracic surgery in our hospital from January 1, 2012: the patients were monitored using routine electrocardiogram combined with invasive arterial blood pressure monitoring, double?lumen central venous catheter pathway was established, and when severe bradycardia ( heart rate<40 beats∕min) occurred, inter?vention was carried out immediately, and chest compression was performed timely. Medical records of 15 212 patients from July 1, 2006 to December 31, 2011 ( before optimizing anesthetic management) as well as medical records of 17 078 patients from January 1, 2012 to January 15, 2015 ( after optimizing an?esthetic management) were reviewed. The data including baseline patient characteristics as well as the time period and causes of cardiac arrest, rescue time, rescue measures, successful resuscitation and prognosis in the patients developing intraoperative cardiac arrest were collected. Before optimizing anesthetic manage?ment, 28 patients developed cardiac arrest, the incidence was 0?184%, successful resuscitation was found in 25 cases, the success rate of resuscitation was 89%, and there were 3 cases in whom resuscitation failed due to massive hemorrhage?induced cardiac arrest. After optimizing anesthetic management, 17 patients de?veloped cardiac arrest, the incidence was 0?109%, massive hemorrhage?induced cardiac arrest was not found in patients, and the success rate of resuscitation was 100%. Prognosis was good after surgery in suc?cessfully resuscitated patients. Compared with the values before optimizing anesthetic management, the in?cidence of cardiac arrest was significantly decreased (P=0?05), and no significant change was found in the other parameters after optimizing anesthetic management ( P>0?05) , and the incidence of cardiac arrest was decreased by 45% after optimizing anesthetic management. In conclusion, the strategy of optimizing anesthetic management is helpful in decreasing the occurrence of cardiac arrest during thoracic surgery.

Objective To investigate outpatients' awareness of the essential medicine system and their intention to use it at county hospitals,analyze the problems in the implementation process and give suggestions.Methods Using questionnaires to survey randomly intercepted patients.Data so acquired were keyed in twice with Epidata 3.0 and SPSS 16.0 was used for analysis featuring descriptive statistics.Results Among the 1064 patients surveyed,only 159 (14.9％)have heard of essential medicines,and the top three ways of awareness were respectively from medical staff,television and Internet; patients pay most attention to drug efficacy in their daily life and the majority of them follow doctors' advices.Conclusion It is necessary to strengthen promotions,formulate diversified publicity strategy,train doctors to guide patients to use essential medicines rationally.

In this consideration,the paper described the imperatives of drug safety,constraints of governance by the government,and advantages of social co-governance,proposing the necessity to establish aFive-in-One (referring to the involvement of the government,enterprises,industry associations,media and the public) drug safety social co-governance.In its analysis of the present dilemma o[drug safety governance,the authors proposed such measures as perfecting legal and institutional system,reforming governmental power allocation mechanism,improving the incentive mechanism,innovating governance means and improving social governance ability,for the purpose of enhancing such a co-governance pattern.

This study compares and analyzes the similarities and differences between National Health Strategy in America and Healthy China 2030 from three aspects, namely the strategic goals, the main contents, and the leading health indicators.Considering China's social and economic environment, this paper proposes the following suggestions: 1) to emphasize the relevance, dynamics and continuity of health strategy;2) to focus on key population on the basis of full coverage;3) to identify the focus of each phase of implementation;and 4) to highly think of the establishment of systems, including information system, operational supervision system and evaluation index system, etc.These suggestions are meant to provide inspiration to the introduction and further development of the China's national health strategy.

Objective:To investigate the effect of the leaching liquids of the pure titanium porcelain crowns with barium titanate coating on the proliferation of L929 cells,and to evaluate its cytotoxicity level.Methods:The L929 ceils were cultured in vitro with leaching liquids of titanium porcelain specimens with barium titanate coating (group A),and titanium porcelain specimens(group B) for 1,3 and 5 days respectively.RPMI1640 containing 10％ fetal bovine serum and 1％ phenol was served as the negative(group C) and positive control group(group D),respectively.MTT method was used to test the effects of barium titanate coating on the proliferation of mouse fibroblast L929 cells,the cytotoxicity of the 4 groups was graded.Results:L929 cells of the group showed normal morphology and vigorous growth except group D.During the whole experiment,the absorbance values of group A was greater than that of group C(P ＜0.05).The cytotoxic gradation of group A grade 0.Conclusion:Titanium porcelain specimens with barium titanate coating has a good cytocompatibility.

Objective To compare the development of intraoperative atrial fibrillation in elderly patients undergoing thoracic surgery using different anesthetic methods in a large sample clinical trial.Methods A total of 1 380 patients of both sexes,aged 60-80 yr,with body mass index of 16-33 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective radical operations for lung or esophageal cancer,were divided into 3 groups (n =460 each) using a random number table:general anesthesia group (group G),general anesthesia combined with paravertebral block group (group GP),and general anesthesia combined with epidural block group (group GE).After induction of anesthesia,an epidural catheter was placed at T4-7 interspace on the operated side,and 0.375％ ropivacaine 8 ml was administrated via the catheter in group GP.After induction of anesthesia,the patients were tracheally intubated and mechanically ventilated,and the end-tidal pressure of carbon dioxide was maintained at 35-45 mmHg in the 3 groups.Maintenance of anesthesia was as follows:propofol was given by target-controlled infusion with the target plasma concentration of 2.5-4.0 μg/ml in the 3 groups;intermittent iv boluses of sufentanil 10 μg were given,and the total dosage was not expected to exceed 1.0 μg/kg in group G;sufentanil 10 μg was injected intravenously when necessary in group GP;0.25％ ropivacaine 5 ml was injected epidurally every 1.5 h in group GE;bispectral index value was maintained at 40-60;rocuronium was injected intravenously according to the condition in the 3 groups.The development of intraoperative atrial fibrillation was recorded.Results The incidence of intraoperative atrial fibrillation was 6.1％,3.7％ and 2.2％ in G,GP and GE groups,respectively.Compared with group G,the incidence of intraoperative atrial fibrillation was significantly decreased in group GE (P＜0.05),and no significant change was found in the incidence of intraoperative atrial fibrillation in group GP (P＞0.05).Conclusion Compared with general anesthesia,general anesthesia combined with epidural block can decrease the development of intraoperative atrial fibrillation,it is more suitable for this type of patients,however,general anesthesia combined with paravertebral block produces no improvement in the development of intraoperative atrial fibrillation in elderly patients undergoing thoracic surgery.

Objective To analyze the influencing factors for doctors' prescription of essential medicines at county hospitals of Anhui province.Methods Multi-stage random sampling method was designed to conduct an investigation for doctors at nine county hospitals in Anhui province,and SPSS 1 6.0 was used to conduct descriptive statistical,chi-square test and binary logistic regression.Results 50.8% respondents reported that they had prescribed essential medicines with the rate of less than 60%. The factors of doctors'prescription for essential medicines are work experience,average monthly income, policy awareness, recognition, training willingness, training times, hospital support, medication preferences,and drug marketing.Conclusion The prescription rate of essential medicines in the sampled hospitals is low,and the targeted comprehensive intervention measures should be taken to promote prescription rate of essential medicines in county hospitals.

ObjectiveTo encourage development of county-level hospitals by building a performance appraisal indicator system for such institutions. Methods Using the PATH model ( a performance appraisal tool for hospital ) quality improvement, an appraisal system was built for such institutions. Centering on patients, this system encompassed such dimensions as public benefits, quality of care and safety, staff and hospital development. Results This system consisted of six level-1 indicators, 21 level-2 indicators and 70 level-3 indicators, each given due weight. Conclusions This indicator system centers on patients, follows guidance of public benefits, and aims at continuous quality improvement, making it an effective in evaluating hospital performance and providing reference for the decision-makers to promote and adjust medical reform policies.

Objective:To evaluate the effect of esketamine on postoperative delirium (POD) in elderly patients undergoing general anesthesia.Methods:Two hundred and twenty-four elderly patients, aged ≥ 65 yr, with American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ, undergoing elective surgery under general anesthesia, were divided into 2 groups ( n=112 each) using a random number table method: esketamine group (S group) and control group (C group). Esketamine 0.5 mg/kg was intravenously injected before anesthesia induction in S group, while the equal volume of normal saline was given instead in C group.The Fuzzy Consciousness Assessment Scale (3D-CAM) was used to assess the occurrence of POD within 7 days after surgery.The consumption of propofol, remifentanil and sufentanil and use of vasoactive drugs were recorded during operation.The rescue analgesia within 48 h after operation and occurrence of postoperative complications were recorded. Results:Compared with C group, the incidence of POD was significantly decreased, the intraoperative consumption of remifentanil was reduced, and the utilization rate of vasoactive drugs, rate of rescue analgesia and incidence of postoperative vertigo, nausea and vomiting within 48 h after surgery were decreased in S group ( P<0.05). Conclusions:Esketamine can reduce the development of POD in elderly patients.

Objective:To evaluate the effective dose, efficacy and safety of remimazolam for induction of general anesthesia in super-elderly patients.Methods:Trial Ⅰ American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ patients of either sex, aged ≥80 yr, with body mass index of 18-25 kg/m 2, undergoing elective surgery with general anesthesia in the Zhejiang Provincial People′s Hospital from January to March 2022, were selected. Remimazolam 0.12 mg/kg or propofol 0.8 mg/kg was intravenously injected in the first patient, and the dose of remimazolam or propofol in the next patient was determined by using the modified Dixon′s up-and-down method. The difference between the two successive doses was 0.01 mg/kg for remimazolam and 0.05 mg/kg for propofol. A positive response was defined as achieving an anesthesia depth (BIS value ≤ 65) within 5 min of administration. If the response was positive, the next patient received a lower dose, or conversely if negative, a higher dose was given in the next patient. The 50% effective dose (ED 50) and 90% effective dose (ED 90) of remifentanil and propofol and their 95% confidence intervals ( CIs) were calculated by Probit method. Trial Ⅱ One hundred and forty-six American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ elderly patients of either sex, aged ≥80 yr, with a body mass index of 18-25 mg/kg, scheduled for elective surgery with general anesthesia from April to October 2023 in Zhejiang Provincial People′s Hospital, were selected and divided into 2 groups ( n=73 each) by using a random number table method: remimazolam group (R group) and propofol group (P group). R group was induced with intravenous remimazolam ED 90 and P group was induced with intravenous propofol ED 90, and the injection time was both 30 s. If the BIS value was still greater than 65 at 5 min after administration, remimazolam 0.05 mg/kg was intravenously added each time in R group and propofol 0.5 mg/kg was intravenously added each time in P group until the patient′s BIS value ≤65. The success of anesthesia induction, time for successful induction of anesthesia and rescue sedation were recorded. The occurrence of intraoperative injection pain, hypertension, hypotension, bradycardia, hypoxemia, intraoperative awareness and postoperative delirium, nausea and vomiting was also recorded. Results:Trial Ⅰ The ED 50 (95% CI) of remimazolam was 0.148 (0.139-0.157) mg/kg, and the ED 90 (95% CI) was 0.160 (0.153-0.202) mg/kg; the ED 50 (95% CI) of propofol was 0.824 (0.726-0.983) mg/kg, and the ED 90 (95% CI) was 0.916 (0.860-2.472) mg/kg. Trial Ⅱ Compared with group P, the time for successful induction of anesthesia was significantly prolonged, the incidence of intraoperative injection pain and hypotension was decreased ( P<0.05), and no significant change was found in the success rate of anesthesia induction, rate of rescue sedation, intraoperative hypertension, bradycardia, hypoxemia, postoperative delirium, and nausea and vomiting in group R ( P>0.05). Conclusions:The ED 50 and ED 90 of remimazolam for induction of general anesthesia are 0.148 and 0.160 mg/kg, respectively, in super-elderly patients. Compared to propofol, remimazolam has a slightly longer onset time, but it is safer when used for induction of general anesthesia in super-elderly patients.