Objective To identify the risk factors for perioperative major adverse cardiac events (MACEs)in elderly patients with coronary heart disease (CHD) undergoing orthopedic surgery.Methods One hundred and twenty-nine patients with CHD,aged ≥65 yr,undergoing elective major orthopedic surgery in our hospital from January 2004 to December 2009,were selected.The patients were assigned into MACE group or non-MACE group according to the occurrence of MACEs during surgery and within 30 days after surgery.Age,sex,history of coronary reconstruction,myocardial infarction,heart failure,angina,systemic angionosis,cerebrovascular disease and diabetes,basic and preoperative blood pressure,routine blood test,serum creatinine,blood glucose,preoperative electrocardiography (ECG) and ultrasonic cardiography,ASA,intraoperative blood transfusion,operation and anesthesia time,entering ICU after surgery and postoperative volume of drainage were recorded.If there was significant difference between the 2 groups,the factor was analyzed using multi-factor logistic regression to select the risk factors for incidence of MACEs.Results Twenty-one patients developed perioperative MACEs (16.3 %).Logistic regression analysis showed that unstable angina within 6 months,preoperative haematocrit ≤ 35%,preoperative ECG arrhythmia and wall motion abnormality were risk factors for incidence of perioperative MACEs in this population (P ＜ 0.05),and the risk indexes of the factors were 5,3,3 and 4,respectively.Conclusion Unstable angina within 6 months,preoperative haematocrit ≤ 35 %,preoperative ECG arrhythmia and wall motion abnormality are risk factors for perioperative MACEs in elderly patients with CHD undergoing orthopedic surgery.

Objective To investigate the anesthesia and perioperative blood management of patients with Marfan syndrome (MS) undergoing scoliosis surgery.Methods The clinical data of MS patients underwent scoliosis surgery from January 2013 to December 2015 in Peking Union Medical College Hospital were collected and compared with patients received the same surgery but without MS.Perioperative information and data on anesthesia and blood management were analyzed.Results Compared with control group,MS patients were found with more preoperative comorbidities with statistical significance,including eye disease,echocardiographic abnormalities,and ventilatory defects.MS patients had significantly more blood loss,more intraoperative and postoperative allogeneic and autologous blood transfusion.The operation time,anesthesia time,and length of postoperative hospital stay were all significantly longer in MS patients.Conclusions MS patients are common with multi-system involvement and comorbidities.Considering the high risk of perioperative bleeding,the anesthesia and blood management for MS patients undergoing scoliosis surgery should be with extra caution.Blood management should be applied and appropriate invasive monitoring methods should be considered when necessary.

Objective To provide theoretical and experimental proof for selecting and implying Tourette's syndrome(TS) animal models, validities of four TS models induced by chemical factors were compared. Methods Four TS models,namely AMP model,APO model,DO1 model and IDPN model were built up by using different chemical modeling agents. Through detecting spontaneous movement, climbing time and monoamine transmitters levels in striatum, four TS animal models were compared and evaluated from three levels of validities-face, prediction,construct. Results Compared with control group, spontaneous movement times raised ( t = 4. 746, P =0. 000) and level of DOPAC ( (0.99 ± 0. 177 ) ng/mg) in striatum increased (P = 0.029 ), and level of NE in striatum decreased in AMP model group( (0.11 ± 0.033 )ng/mg, P = 0.012). Compared with control group, climbing time prolonged (P = 0. 004) and levels of DA ( ( 10. 19 ± 1.23 ) ng/mg), 5-HT ( ( 0. 54 ± 0.08 ) ng/mg) in striatum raised(P=0. 019, P=0. 002),at the same time ,levels of DOPAC( (0.63 ±0.11 )ng/mg),HVA ((0.45 ±0.04 ) ng/mg) in striatum reduced (P ＜ 0.01 ) in APO model group; Compared with control group, levels of DA ( ( 13.66 ± 1.55 ) ng/mg), DOPAC( (0.80 ±0. 11 ) ng/mg), HVA( ( 1.04 ± 0.14) ng/mg) grew downwards in striatum of DOI model mice(P=0.029,P=0.001, P= 0.004). Compared with control group, level of 5-HT in striatum increased in IDPN300 group ( (0.77 ± 0.09) ng/mg, P = 0.031 ). ConclusionFace validity of AMP model is temporal and that of IDPN model is steady and persistent. AMP model,APO model and DOI model possess predictive validity. AMP model,APO model,DOI model and IDPN model have potentiality of becoming construct validity model.

Objective To compare the experience of perioperative management and anesthesia in VHL syndrome and non-VHL patients undergoing pheochromocytoma resection .Methods 50 patients scheduled for surgical removal of pheochromocytoma in PUMC Hospital from 2009-01-01 to 2014-12-31 were included in this retrospective analysis . Among them,12 patients were diagnosed with VHL syndrome ,others were non-VLH patients.We focused on the clini-cal records , especially clinical manifestation , preoperative preparation , intraoperative anesthetic management , opera-tion duration and postoperative hospital stay .Results Comparing with non-VHL patients , VHL syndrome patients undergoing pheochromocytoma resection surgery were much younger , with multiple pheochromocytoma and a signifi-cantly increased norepinephrine release .The drug preparation period was much longer , as well as the operative time and hospital stay (P<0.05).But no statistical difference existed in the intraoperative hemodynamic fluctuation and the outcomes of the patients .Conclusions VHL syndrome patients mainly present with multiple pheochromocytoma which has more aggressive function .Since the long operation duration and high risk , the optimization of perioperative management and adequate drug preparation are the key factors to ensure the operation safety .

0.05). Compared with model group, levels of DA and DOPAC in striatum reduced in Xieqing group (P

Objective To explore the clinical value of resistance index(RI)of prostatic capsular artery in predicting or screening of prostate cancer(PCa)by comparing prostatic capsular artery RI with the serum total prostatic specific antigen(TPSA),fPSA/tPSA ratio and prostatic specific antigen dernsity(PSAD).Methods RI of prostate capsular artery,serum TPSA,of fPSA/tPSA ratio and PSAD were measured with colour Doppler ultrasonography in this subset of 203 patients who had undergone transrectal ultrasound guided prostate puncture biopsy.The patients were divided into two groups [PCa and benign prostatic hyperplasia(BPH)group] for comparative study.Results Of them,the level of TPSA were between 4 and 10 ng/ml(grey area)in 34 cases,accounts for 16.75%of the total subjects.All the others were outside the grey area.ROC curve analysis showed that the area under the curve(AUC)of RI of the capsular artery was 0.77,which was close to 0.84 and 0.86 of TPSA and PSAD.It indicated a similar value in predicting or screening PCa; while the AUC of fPSA/tPSA ratio was only 0.49,which had little clinical value.The fPSA/tPSA ratio and the mean value of PSAD in the grey area had significant differences(t=2.78,3.94,P＜0.02)between the two groups.However,the fPSA/tPSA ratio had no statistical significance in the high value area outside the grey area(t=0.873,P ＞ 0.05).And the mean value of RI of prostatic capsular artery had significant differences between the two groups both in the grey area and in the high value area outside the grey area(t=4.56,5.10,P ＜ 0.001).Conclusions RI of prostatic capsular artery can be steadily used to predict or screen PCa.It is not affected by the gray area of TPSA and is of great value in clinical practice.

Objective:To investigate the cognition and clinical practice status of Enhanced Recovery After Surgery (ERAS) among anesthesiologists in secondary hospitals in China using a questionnaire, trying to provide some references for the promotion and popularization of ERAS across China.Methods:From April to November 2021, anesthesiologists in secondary public hospitals across the country were enrolled by convenience sampling and investigated by a self-designed questionnaire on the cognition, clinical practice status and their teaching needs about ERAS.Influencing factors of ERAS cognition were then analyzed.Results:Totally 879 questionnaires were sent out, 864 were effectively received with effective recovery of 98.3%.The anesthesiologists in this survey were distributed in 31 provincial administrative regions across the country.The score of the ERAS cognition (total score of 18) was 12.00 (3.75), and 563 participants (65.2%) were qualified on cognitive status (score ≥ 12). Geographic region, age, educational qualification, professional title and length of occupation were found to have significant influence on ERAS cognition ( P<0.05). Among the anesthesiologists who participated in the survey, 817 participants (94.6%) recognized that ERAS management was beneficial to patients, and 778 (90.0%) of them agreed that ERAS management should be carried out as much as possible in secondary hospitals.Two hundred and fifty-five (29.5%) participants had never implemented ERAS management in clinic anesthesia.There were significant differences in the ERAS practice status among participants from different geographical regions in China ( P<0.05). Eight hundred and forty-eight (98.1%) anesthesiologists who participated in the survey expressed their willingness to receive further systematic training on ERAS, and taking online courses and reading books were the current main ways to obtain related knowledge. Conclusions:The cognition and clinical practice status of ERAS need to be improved among anesthesiologists in secondary hospitals in our country.Sustained ERAS education programs with various forms should be carried out in subgrade medical care centers in order to continuously promote the extensive practice of ERAS across China.

Objective To summarize experience and characteristics of the perioperative anesthetic management of patients with active infective endocarditis (AIE) undergoing cardiac valve surgery under cardiopulmonary bypass (CPB).Methods A total of 117 patients of both sexes,aged 18-70 yr,of American Society of Anesthesiologists physical status Ⅱ-Ⅳ,undergoing cardiac valve surgery under CPB from January 2014 to June 2015 in Peking Union Medical College Hospital,were enrolled in the study and divided into AIE group (n =57) and non-AIE group (n =60).Anesthesia was induced by Ⅳ injection of midazolam 1-2 mg,etomidate 0.15-0.30 mg/kg,sufentanil 0.3-0.5 μg/kg and rocuronium 0.6-1.0 mg/kg.After orotracheal intubation,the patients underwent high-frequency volume-controlled ventilation with low tidal volume,and positive end-expiratory pressure was increased appropriately.Esophageal echocardiography was used for evaluation.Anesthesia was maintained by inhalation of 1.0％-1.5％ sevoflurane,intermittent Ⅳ boluses of sufentanil 0.2-0.3 μg/kg and Ⅳ infusion of piperium bromide 2 mg/h,and the bispectral index value was maintained between 40-60 during surgeDy.Sensitive antibiotics were given during surgery according to the results of preoperative blood culture in AIE group.The following data were collected:baseline patient characteristics,preoperative blood routine,erythrocyte sedimentation rate,concentrations of hypersensitive c-reactive protein and amino-terminal pro-brain natriuretic peptide,operation time,CPB time,intraoperative consumption of vasoactive drugs,fluid intake and output,use of antibiotics,length of postoperative intensive care unit stay,extubation time,new invasive operation (intra-aortic balloon counterpulsation was performed),time for use of vasoactive drugs,postoperative 24 h drainage,length of hosptial stay,serious complications (postoperative bleeding,pericardial tamponade,severe arrhythmia,heart failure,acute lung injury,renal failure and other organ function failure,etc.) and development of death.Results Compared with non-AIE group,age,body mass index and preoperative Hb,Hct,systolic blood pressure and diastolic blood pressure were significantly decreased,the rate of preoperative hypertension,neutrophil count,erythrocyte sedimentation rate,concentrations of hypersensitive c-reactive protein and amino-terminal pro-brain natriuretic peptide,body temperature and heart rate were increased,the intraoperative volume of allogeneic blood transfused and consumption of norepinephrine,phenylephrine and ephedrine after CPB were increased,the time for postoperative use of vasoactive drugs,extubation time and length of postoperative intensive care unit stay were shortened,and the length of hospital stay was prolonged in AIE group (P＜0.05).Conclusion For the patients with AIE undergoing cardiac valve surgery under CPB,comprehensive evaluation should be performed and heart failure be corrected actively before surgery;esophageal echocardiography should be used for evaluation,the application of vasoactive drugs could be increased appropriately and anesthetists should pay attention to respiratory management during surgery;cardiotonic and anti-shock therapy should be maintained,arrhythmia prevented and anti-infective therapy strengthened after surgery.

Objective To evaluate the use of endoscopic papillary balloon dilation in treatment of choledocholithiasis associated with peripapillary duodenal diverticulum.Methods From January 2017 to July 2018,a retrospective study was conducted on 124 patients with choledocholithiasis associated with peripapillary duodenal diverticula at the Department of Hepatobiliary Surgery,Second Hospital of Hebei Medical University.These patients were divided into the small endoscopic sphincterotomy combined with balloon dilation group (sEST+EPBD,n =60) and the simple papillary balloon dilation group (EPBD n =64).The operation time,one-time success rate of stone removal,complication and hospitalization stay were compared between the two groups of patients.Results The hospitalization expenses of the EPBD group was significantly less than the sEST+EPBD group (P＜0.05).The operation time of the EPBD group was significantly shorten than the sEST+EPBD group (P＜0.05).There were no significant differences in the one-time success rate of stone removal,complication rates and hospitalization stay between the two groups (P＞0.05).Conclusions Compared with sEST+EPBD,treatment of choledocholithiasis in patients with peripapillary duodenal diverticula using simple balloon dilation shortened the operation time,did not increase the complication rates and hospitalization stay.The procedure was safe and effective,and resulted in almost the same one-time success rate of stone removal.

Objective To explore the practice and significance of the new course of"Enhanced Recovery after Sur-gery(ERAS)and Perioperative Management"for graduate students under multidisciplinary cooperation.Methods The Department of Anesthesiology collaborated with the Department of Clinical Nutrition,Department of Geriatrics and six related surgical departments to develop a course of 30 credit hours on"ERAS and Perioperative Manage-ment"in Peking Union Medical College Hospital.Researchers analyzed the teaching effectiveness of the course by collecting survey questionnaires and evaluating scheme report of ERAS case.Results Researchers found that ten graduates joined this course and they believed that learning improved their understanding of ERAS related knowl-edge,such as preoperative nutrition and functional state optimization,intraoperative volume and temperature man-agement,prevention of postoperative nausea and vomiting,and perioperative pain management.Students had high satisfaction with the course and believed that it would help improve their clinical literacy.Conclusions The new course of"ERAS and Perioperative Management"for graduates may support capacity building in terms of clinical logic and thinking about ERAS and promotion of skills for perioperative management.Our experience of graduates′training with"Enhanced Recovery after Surgery and Perioperative Management"course can be shared by other trainers of health institution of China.