Objective:To systematically evaluate the incidence of liver injury in multi-drug resistant tu-berculosis ( MDR-TB ) patients with the treatment of second-line anti-TB drugs.Methods: Medline (January 1, 1966 to March 1, 2014), Embase (January 1, 1974 to March 1, 2014) and the Cochrane library (January 1, 1993 to March 1, 2014) with four Chinese databases including VIP ( January 1, 1989 to March 1, 2014), CBMDisc (January 1, 1978 to March 1, 2014), CNKI (January 1, 1994 to March 1, 2014)and Wanfang (January 1, 1998 to March 1, 2014), were systematically searched with the keywords including “Tuberculosis”,“multidrug-resistant”,“MDR-TB”,“side effect”,“adverse”,“safety” and “tolerability” for the follow-up studies of MDR-TB patients with liver injury during the treatment of second-line anti-TB drugs.The relevant information was extracted and the data were analyzed using the random-effects model .Subgroup and sensitivity analyses were performed based on the diagnostic criteria, study population , study design , history of anti-TB treatment and treatment length .Results: A total of 26 articles with 3 875 MDR-TB patients were included , of which 373 patients developed liver in-jury, and the weighed combined incidence of liver injury was 7.7%(95%CI:5.5%-10.8%).There was some heterogeneity among the studies .Subgroup analyses showed that the incidence of liver injury was higher in groups with treatment length≥18 months and non-Asian populations , but there was no sig-nificant difference between the groups (P>0.05).Among the 26 articles, only nine of them reported the diagnostic criteria of liver injury , while the criteria were not uniform .Conclusion:The incidence of liver injury during the treatment of second-line anti-TB drug in MDR-TB patients was high , and the diag-nostic criteria were not uniform .We should pay attention to the prevention and treatment of liver injury , and develop standard diagnostic criteria for it .

Objective To assess the risk factors of multidrug-resistant organism(MDRO)healthcare-associated pneumonia(HCAP).Methods The case-control study was conducted in patients admitted to 22 hospitals in 4 cities between April 1 ,2013 and December 31 ,2013,patients with HCAP caused by MDRO (MRSA,MDRPA,MDRAB, ESBL KP,ESBL E.coli)(drug-resistant group )and drug-sensitive organisms (MSSA,PA,AB,KP,E.coli)(drug-sensitive group )were surveyed .Univariate and multivariate statistical analysis methods were used to evaluate the risk factors for MDRO HCAP.The prognosis,cost and length of hospital stay between drug-resistant group and drug-sensitive group were compared .Results A total of 1 656 patients were included in the study ,including 43 pa-tients (2.60%)with mixed infection caused by both drug-resistant and drug-sensitive organisms ;there were 927 ca-ses (55.98%)in drug-resistant group and 772 cases(46.62%)in drug-sensitive group .Logistic regression model re-vealed that admission to ICUs (OR 95%CI :1 .55[1 .14-2.11]),mechanical ventilation (OR 95%CI :1 .45[1 .15-1 .84]),arteriovenous catheterization (OR 95%CI :1 .29 [1 .02 - 1 .63 ]),fiberbronchoscopy (OR 95%CI :1 .46 [1 .02-2.09]),antimicrobial use(OR 95%CI :1 .63[1 .20-2.22]),chronic lung diseases (OR 95%CI :1 .54[1 .13-2.10]),and chronic cardiovascular and cerebrovascular diseases (OR 95%CI :1 .42[1 .15-1 .74])were independ-ent risk factors for MDRO HCAP .Compared with drug-sensitive group ,drug-resistant group prolonged length of hospital stay by an average of 5.89 days,increased hospitalization and antimicrobial expense by ￥40 739.30 and￥2 805.80 respectively;prognoses was worse,risk factor was 1 .66-fold of drug-sensitive group(OR 95%CI :1 .16-2.35).Conclusion Admission to ICUs,invasive operations,antimicrobial use,chronic lung diseases and chronic cardiovascular and cerebrovascular diseases can increase the risk of MDRO HCAP .

Objective This study aims to investigate the current status of burnout among anesthesi-ology residents,and to explore its influencing factors and potential interventions.Methods A total of 2 651 practicing anesthesiology residents from 218 hospitals nationwide were included in this study.Demographic characteristics,occupational features,and psychological resilience scores(Connor-Davidson resilience scale)were collected using a questionnaire distributed electronically.The Maslach burnout inventory-human service survey(MBI-HSS)was used to assess burnout.A comparison between groups with and without occu-pational burnout was conducted.Multiple logistic regression analysis was used to identify risk factors for burnout among anesthesiology residents.Results Out of the expected 2 651 questionnaires,1 990 valid responses were received(response rate 77.7%).The prevalence of burnout among the residents was 53.4%(1 063/1 990).Compared with residents without occupational burnout,those with burnout had a signifi-cantly higher proportion of females,working in tertiary hospitals,unmarried individuals,frequency of en-countering challenging patients,participating in on-call duty,and research tasks,and had a significantly lon-ger weekly working hours(P＜0.05).Multivariate logistic regression analysis indicated that female(OR = 1.58,95%CI 1.28-1.97,P＜0.01),longer working hours(OR = 1.62,95%CI 1.45-1.81,P＜0.01),and higher frequency of encountering challenging patients(OR = 1.11,95%CI 1.11-1.40,P＜0.01)were risk factors for occupational burnout.High levels of psychological resilience was protective factor against burnout(OR = 0.86,95%CI 0.84-0.88,P＜0.01).Conclusion The occurrence of burnout among anesthesiology residents is high.It is crucial to focus on and design practical preventive measures to en-hance psychological resilience,ensuring healthy physical and mental development of the resident community.

Academic Dissertations as Topic ; Cross Infection ; epidemiology ; prevention & control ; Infection Control

Objective:To compare the effects of different anesthetic methods on the prognosis in the patients with stage Ⅲ breast cancer.Methods:Based on a multicenter randomized controlled trial (NCT00418457), 274 patients with untreated stage Ⅲ breast cancer, aged 18-85 yr, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, were enrolled in the study and assigned to thoracic paravertebral block (TPVB) combined with total intravenous anesthesia group (TPVB+ TIVA group, n=141) and general anesthesia group (GA group, n=133) by computer-generated randomization stratified by study site.The primary outcome parameter of this study was postoperative recurrence rate.The secondary outcome parameters were the degree of postoperative acute pain (assessed using visual analogue scale score), the incidence of postoperative nausea and vomiting (PONV), postoperative hospital stay time, and the incidence of persistent pain after breast cancer surgery (PPBCS) at 6 and 12 months after surgery (assessed using the modified Brief Pain Inventory). Results:Compared with group GA, no significant change was found in the postoperative recurrence rate ( HR=0.711, 95% confidence interval (CI) 0.418-1.210, P=0.209), the degree of postoperative acute pain and the incidence of PONV were decreased (mean difference ( MD) of visual analogue scale score -0.890, 95% CI -1.344--0.436, P<0.001; OR=0.236, 95% CI 0.083-0.674, P=0.007), and no significant change was found in postoperative hospital stay time and the incidence of PPBCS ( HR=1.000, 95% CI 0.778-1.286, P=1.000; OR=2.100, 95% CI 0.599-7.362, P=0.246) in group TPVB+ TIVA. Conclusion:Compared with general anesthesia alone, TPVB combined with total intravenous anesthesia can provide lower degree of postoperative acute pain and lower incidence of PONV, and exert no effects on postoperative recurrence, postoperative hospital stay time and PPBCS in patients with stage Ⅲ breast cancer.

Objective Using our team's recent research achievement"the cervical ultrasound scanning route map"as a teaching tool,to evaluate its impact on the learning effectiveness and confidence of beginners in the process of learning cervical spinal ultrasonography.Methods This study is a before and after self-control study.After recruit-ment of 40 cervical ultrasound beginners,they had completed questionnaire 1.The questionnaire was designed with three self-assessment questions on theoretical knowledge of cervical spinal ultrasound,three self-assessment ques-tions on practical skills of cervical spinal ultrasound and one question on willingness to use cervical spinal ultra-sound in the future.After traditional teaching without involving the route map,beginners completed questionnaire 2 with the same content.After a 20 min break,teacher introduced and explained the route map to the beginners,then the beginners completed questionnaire 3.Questions related to satisfaction with this learning experience had been added to questionnaire 3.The answers to all questions were scored on a scale of 1-10.In this study,the main out-come was the comprehensive learning score,calculated as(sum score of theoretical knowledge+sum score of prac-tical skills+score of willingness to use cervical ultrasound in the future)/7.Results Beginners'comprehensive learning score at the three time points were 2.9±1.3,4.8±1.8,5.7±1.8,F(2,22)= 52.11,P＜0.001,partial Eta squared=0.83.After introducing the route map,their comprehensive learning score increased 1.0(95%CI:0.46-1.49)(P＜0.001)compared to scores after traditional training.Conclusions The route map may significantly improve learning effectiveness and confidence of beginners in the field of cervical spinal ultrasonography and can be used as a routine training tool in the teaching of cervical spinal ultrasonography.

Objective:To evaluate the effect of teacher-assisted jaw thrust maneuver on the learning effectiveness of Bonfils fiberscope-guided tracheal intubation for the beginners.Methods:Forty-eight accompanying physicians who were receiving residents standardized training in the Department of Anesthesiology, Peking Union Medical College from April, 2020 to March 2021 and served as trainees were enrolled in this study.The trainees received Bonfils fiberscope training and were randomly divided into independent group ( n=24) and assisted group ( n=24). After induction of general anesthesia, the trainees independently performed the Bonfils fiberscope-guided endotracheal intubation operation in independent group, and trainees performed the operation with the assistance of the teacher′s jaw thrust maneuver in assisted group.The success of intubation at first attempt, duration of intubation, times of teachers′ guidance and scores for trainees′ learning confidence were recorded. Results:Compared with independent group, the success rate of intubation at first attempt was significantly increased, the duration of intubation was shortened, scores for trainees′ learning confidence was increased ( P<0.05), and no significant change was found in the times of teachers′ guidance in assisted group ( P>0.05). Conclusion:For the beginners learning Bonfils fiberscope-guided tracheal intubation, teacher-assisted jaw thrust maneuver is helpful in raising the learning effectiveness and increasing the beginners′ learning confidence.

Objective This study compared the effects of intraoperative intercostal nerve block(ICNB)and preoperative ultrasound-guided paravertebral block(US-PVB)on postoperative complications in patients undergoing thoracoscopic lung surgery.Methods Data from 240 patients who underwent video-assisted thoracoscopic lung surgery under general anesthesia between January 2019 and December 2020 was retrospectively collected.These patients either received intraoperative intercostal nerve block(ICNB)(202 cases)or pre-operative ultrasound-guided paravertebral block(US-PVB)(38 cases).The incidence rates of overall postoperative complications,postoperative pulmonary complications,postoperative cardiac complications,postoperative cerebral complications,other postoperative complications,remedial analgesia requirement in the PACU,intraoperative fentanyl consumption,postoperative oral morphine equivalent(OME),perioperative OME,duration of postoperative drainage tube,postoperative ICU stay,and postoperative hospital stay were compared between the ICNB group and the US-PVB group.Univariate and multivariate regression were used to analyze the effects of different analgesia methods on postoperative complicationsResults There was no statistically significant difference in postoperative overall complications between the ICNB group and the US-PVB group(P＞0.05).In the univariate analysis,no significant difference was found in the overall postoperative complications between the ICNB group(16.3％)and the US-PVB group(13.2％)(OR=0.642,95％CI 0.239-1.786;P=0.404.Multivariate analysis also did not reveal any differences between the two groups(OR=0.843,95％CI 0.299-2.377;P=0746).For the analysis of secondary outcomes,according to multivariate analysis,there was no significant difference between the two groups in postoperative pulmonary complications,postoperative cardiac complications,other postoperative complications,remedial analgesia requirement in the PACU,intraoperative fentanyl consumption,postoperative OME,perioperative OME,duration of postoperative drainage tube,postoperative ICU stay or postoperative hospital stay(P＞0.05).Conclusion In this study,we found no difference in postoperative complications between intraoperative ICNB and preoperative US-PVB.

Objective:To investigate the incidence and influencing factors of anastomotic leakage after laparoscopic anterior resection for rectal cancer.Methods:The retrospective case-control study was conducted. The clinicopathological data of 804 patients with rectal cancer who were admitted to Peking Union Medical College Hospital of Chinese Academy of Medical Sciences from January 2017 to December 2019 were collected. There were 521 male and 283 female, aged 63(range, 27-94)years. All 804 patients underwent laparoscopic anterior resection for rectal cancer. Observation indicators: (1) surgical situations; (2) incidence of postoperative anastomotic leakage; (3) follow-up; (4) influencing factors of postoperative anastomotic leakage; (5) subgroup analysis. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribu-tion were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Univariate analysis was conducted using the chi-square test or independent sample t test. Factors with P≤0.2 in univariate analysis were included in multivariate Logistic regression analysis. Results:(1) Surgical situations. All 804 patients underwent laparoscopic radical resection of upper and middle rectal cancer successfully, with the operation time and volume of intraoperative blood loss as 135(range, 118-256)minutes and 30(range, 5-350)mL. All 804 patients completed end-to-end colon rectal anastomosis, including 287 patients with reinforced sutures at the anastomotic site, and 517 patients with routine anastomosis. (2) Incidence of postoperative anastomotic leakage. Of the 804 patients, 40 patients had postoperative anastomotic leakage, with the incidence rate as 4.98%(40/804). (3) Follow-up. All 804 patients were followed up for 32(range, 6-49)months. None of patient died during the perioperative period. (4) Influencing factors of postoperative anastomotic leakage. Results of multivariate analysis showed that unreinforced suture at the anastomotic site was an independent risk factor for postoperative anastomotic leakage ( odds ratio=2.78, 95% confidence interval as 1.21-6.37, P<0.05). (5) Subgroup analysis. Of the 804 patients, 202 patients received neoadjuvant therapy and 602 patients did not receive neoadjuvant therapy. Of the 602 patients who did not receive neo-adjuvant therapy, cases with postoperative anastomotic leakage was 6 in the 253 patients with reinforced sutures, versus 21 in the 349 patients with routine sutures, showing a significant difference between them ( χ2=4.56, P<0.05). Conclusion:Unreinforced anastomosis at the anasto-motic site is an independent risk factor for anastomotic leakage after laparoscopic anterior rectal resection, especially for rectal cancer patients without neoadjuvant radiochemotherapy.

Background::Digestive system cancers constitute a significant number of cancer cases, but their burden is not uniform. As Global Cancer Observatory (GLOBOCAN) 2022 has recently updated its estimates of cancer burden, we aimed to investigate the burden of six major digestive system cancers both worldwide and in China, along with geographical and temporal variations in cancer-specific incidence and mortality.Methods::We extracted data on primary cancers of the esophagus, stomach, colorectum, liver, pancreas, and gallbladder from the GLOBOCAN database for 2022. Age-standardized incidence and mortality rates were calculated and stratified by sex, country, region, and human development index (HDI). We used the 2022 revision of the World Population Prospects (United Nations) to obtain demographic data for various age groups in China from 1988 to 2012 and used the joinpoint model and the average annual percentage change (AAPC) to analyze cancer incidence trends in China.Results::In 2022, the estimated global incidence of digestive system cancers reached 4,905,882, with an estimated 3,324,774 cancer-related deaths. Colorectal cancer was most prevalent in terms of incidence and mortality. There was a significant correlation between the burden of gastrointestinal cancers and country HDI. From 1988 to 2012, the incidence of esophageal, gastric, and liver cancers declined in China, whereas colorectal and pancreatic cancer incidences continued to increase. By 2050, colorectal and liver cancers are projected to remain the leading cancer types in China in terms of incidence and mortality, respectively.Conclusions::Digestive system cancers remain a significant public health challenge globally and in China. Although progress has been made in the prevention and control of some cancers, the burden of digestive system cancers persists. The implementation of tertiary prevention strategies must be intensified to reduce the incidence and mortality of digestive system cancers, mitigating their impact on public health.