To investigate the incidence of postoperative neuropsychic dysfunction (PND) in Parkinson's disease (PD) patients undergoing deep brain stimulation (DBS) and to analyze its influencing factors.

Objective To explore the effect of sugammadex on safety indicators such as body movement,choking,peak airway pressure during spinal surgery with motor evoked potential monitoring.Methods This study was a ret-rospective analysis of two randomized controlled trials.Patients undergoing selective thoracic and lumbar spinal sur-gery with intraoperative motor evoked potential monitoring were included.Rocuronium was continuously infused and the train-of-four stimulation count was maintained at 2.When motor evoked potential monitoring started,stop rocu-ronium infusion and 2 mg/kg of sugammadex was given.Indicators were compared between administration of sugam-madex and 5,10,20,30,60 minutes after administration like body movement,choking,peak airway pressure,allergic reaction,mean arterial pressure,heart rate,end expiratory pressure of CO2 and the train-of-four stimulation ratio(TOFr).Results A total of 120 patients were finally included in the analysis.Before administering sugammadex,TOFr was 0.2.At 5,10,20,30 and 60 minutes after administration,TOFr were 0.8,0.8,0.9,0.9,0.9 respectively.No patient experienced intraoperative body movement,choking,or allergy reaction.Compared with the time of sugamma-dex administration,heart rate was significantly reduced 5,10,20,30 and 60 minutes after administration(P＜0.05),there was no significant change in the remaining indicators.Conclusions Sugammadex can be safely used during spinal surgery with motor evoked potential monitoring.

Objective Feasibility application of microelectrode recording(MER)during sub thalamic nucleus deep brain stimulation(STN-DBS)implantation under desflurane general anesthesia(GA)in patients with Par-kinson's disease(PD).Methods A prospective cohort of 20 PD patients undergoing STN-DBS under desflurane general anesthesia were enrolled.Intraoperative MER quality,pos-operative acute pain,cognitive function,anxi-ety/depression status,quality of life,and clinical efficacy of DBS were evaluated.Results Among the patients,14 were male with average PD duration of(8.1±3.6)years.Hoehn-Yahr staging averaged 2.8±0.5 in"on"state and 2.3±0.5 in"off"state.The mean DBS surgery duration was 87.4 minutes.Highly normalized root-mean-square(NRMS)signals were successfully recorded in all cases,with remedial measures applied in 4 pa-tients to achieve satisfactory MER signals.Post-operative Visual Analogue Scale(VAS)pain scores on days 1,2,and 3 were 3.7±2.2,2.8±1.6,and 1.8±2.0,respectively.Montreal Cognitive Assessment(MoCA)scores showed no statistical difference during hospitalization as compared to pre-operative values,but significantly de-creased at 6-month follow-up(24.3±4.1 vs.21.5±3.5,P＜0.05).All patients demonstrated significant reduc-tion in Hamilton Anxiety Scale(HAMA),Hamilton Depression Rating Scale(HAMD),and Parkinson's disease Questionnaire-39(PDQ-39)scores at 6-month follow-up.The unified Parkinson's disease rating scale(UPDRS-Ⅲ)improvement rates were 51.4%±39.2%(medication-on)and 61.6%±26.8%(medication-off)respectively with Levodopa Equivalent Daily Dose(LEDD)improvement rate of 48.6%±23.0%.Conclusions Desflurane general anesthesia is safe and feasible for electrods implantation in STN-DBS of PD patients,without interfering with intra-operative MER or postoperative outcomes.

Objective To observe the effects of epidural anesthesia and subarachnoid anesthesia on puerperants and fetus perioperatively undergoing cesarean delivery after epidural labor analgesia.Methods A retrospective cohort study was conducted to select and analyze the relevant clinical data of women who had epidural labor anal-gesia and were converted to cesarean delivery at Beijing Tiantan Hospital.According to the anesthesia method of cesarean section,the participants were divided into the epidural anesthesia(EA)group and the subarachnoid an-esthesia(SA)group.That were aimed to compare the effects of the two anesthesia methods on the mother and fe-tus perioperatively.Results Compared with women in the epidural anesthesia group,women in the subarachnoid anesthesia group had a better anesthesia outcome,visual analogue scale(VAS)scores,frequency(%)[VAS scores 0-3:5(25%)vs.14(70%);VAS scores 4-6:12(60%)vs.6(30%);and VAS scores 7-10:3(15%)vs.6(30%)],and higher perioperative complication rate.There was nonsignificance difference in perio-perative maternal bleeding,neonatal Apgar score,and neonatal umbilical artery blood gas analysis between the two groups.Conclusions In women with epidural analgesia undergoing cesarean section,the anesthesia effect of subarachnoid anesthesia is better than that of the epidural anesthesia.The anesthesiologist must pay attention to prevent complications in the perioperative period.

Objective To develop and validate a prediction model for severe disability or death(SDD)in acute ischemic stroke(AIS)patients who underwent endovascular treatment(EVT).Methods Based on the dataset of ANGEL-ACT study who received EVT for AIS between november 2017 and march 2019,a retrospective analysis was performed on 1 677 patients,including 1 111 males and 566 females,aged ≥ 18 years.Patients were divided into two groups according to whether SDD occurred(mRS 5-6 scores 90 days after surgery):SDD group(n=478)and non-SDD group(n=1 199).Risk factors that might influence SDD after EVT in AIS patients were screened and analyzed by multifactorial analysis,LAS-SO regression,and RF-RFE methods.A nomogram was developed after evaluating the model performance and the execution of internal validation.Results SDD occurred in 380(28.1％)patients in the develop-ment cohort and 98(30.2％)patients in the validation cohort.Combining the three variable screening meth-ods,10 risk factors were selected for inclusion in the final model:age,NIHSS score,whether successful re-canalization,glucose level,hemoglobin,hematocrit,onset to puncture time,systolic blood pressure,AS-PECT score,and whether have treatment-related serious adverse events.A two-stage model means that model 1 contains pre-treatment variables(7 in total)and model 2 contains pre-treatment and post-treatment variables(10 in total).The area under the curve(AUC)of model 1 in the development cohort was 0.705(95％CI 0.674-0.736)and 0.731(95％CI 0.701-0.760)in model 2.Both models had good calibration with aslope of 1.000,and the decision curve analysis showed good clinical applicability.The results of the validation cohort were similar to those of the development cohort.Conclusion Age,admission NIHSS score,whether successful recanalization,admission glucose level,hemoglobin content,erythrocyte pressure volume,onset to puncture time,admission systolic blood pressure,ASPECT score,and whether have treat-ment-related serious adverse events are risk factors for SDD in patients with acute ischemic stroke.The two prediction models based on the above factors were used before and after endovascular treatment to predict SDD occurrence better.

Objective:To identify the risk factors for chronic postsurgical pain (CPSP) after craniotomy.Methods:This was a single-center retrospective cohort study.The patients who underwent craniotomy in Beijing Tiantan Hospital, Capital Medical University from December 2019 to May 2020 were enrolled.The occurrence of CPSP, anxiety, depression and quality of life were determined by telephone follow-up with Short-form McGill Pain Questionnaire-2, Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-Item, a five-level EuroQol five-dimensional questionnaire.The patients were divided into CPSP group ( n=106) and non-CPSP group ( n=252) according to the results of investigation.Then univariate analysis and logistic regression analysis were performed to identify the risk factors for CPSP. Results:There was significant difference in age, a history of preoperative pain, a history of alcohol addiction, transoccipital approach and degree of lesion resection between the two groups ( P<0.05). The results of logistic regression analysis showed that age ≥ 60 yr was a protective factor for CPSP after craniotomy; a history of preoperative pain ≥3 months, a history of alcohol addiction, transoccipital approach and partial resection of the lesion were independent risk factors for CPSP after craniotomy. Conclusion:Age≥60 yr is a protective factor for CPSP after craniotomy; a history of preoperative pain (≥3 months), a history of alcohol addiction, transoccipital approach and partial resection of the lesion are independent risk factors for CPSP after craniotomy.

Objective To investigate the effect of different concentrations of morphine on the viability of cortical neurons and synaptic plasticity in newborn mice.Methods Cortical neurons isolated from male C57/BL/6 mice within 24 h after birth were seeded in 60-mm cultured dish (10 ml),24-well plates (500 ml) and 96-well plates (100 ml) at a density of 2×106,1×105 and 1.5×104 cells per plate/well,respectively,and cultured for 7 days.Neurons were then divided into 4 groups (n =6 each) using a random number table method:control group (group C),morphine 1.0 mmol/L group (group M1),morphine 10.0 mmol/L group (group M2),and morphine 100.0 mmol/L group (group M3).Neurons were incubated for 48 h with morphine 1.0,10.0 and 100.0 mmol/L in M1,M2 and M3 groups,respectively.MTT assay was used to measure the cell viability,immunofluorescence to measure the length of microtube-associated protein-2-labeled dendrites,and Western blot to detect the expression of caveolin-1 (Cav-1),growth-associated protein-43 (GAP-43),synapsin,synaptophysin Ⅰ and vesicle-associated membrane protein.Results Compared with group C,the length of dendrites was significantly prolonged,and the expression of Cav-1,GAP-43,synapsin,synaptophysin Ⅰ and vesicle-associated membrane protein was up-regulated in group M2,and the cell viability was significantly decreased,and the expression of Cav-1,GAP-43 and vesicle-associated membrane protein was up-regulated in group M3 (P＜ 0.05).Conclusion Morphine 10.0 mmol/L causes no damage to cortical neurons and enhances synaptic plasticity of neurons in newborn mice.

Objective To evaluate protective ventilation(PV) versus conventional ventilation(CV) for surgery in the prone position.Methods We searched PubMed, Embase, the Cochrane Library, WanFang Data and other Chinese databases to collect the randomized controlled trails (RCTs) on intraoperative PV in comparison with CV for surgery in the prone position.Two authors independently identified the studies, performed data extraction and assessed the risks of bias in the included studies according to the Cochrane Handbook for Systematic Reviews of Interventions.The reviewers conducted data analyses with RevMan software.Results A total of 9 RCTs involving 449 participants were included.The results showed that the incidence of postoperative pulmonary complications (RR 0.30, 95% CI 0.12~0.73, P<0.01) and peak pressure (MD-3.52, 95% CI-6.93~-0.11, P<0.05) were lower in the PV group.Intraoperative PaO2/FiO2 was higher (MD 37.28, 95% CI 22.67~51.89, P<0.001) and alveolar-arterial oxygen difference was lower (MD-45.50, 95% CI-61.35~-29.65, P<0.001) in the PV group.Conclusions Low tidal volume ventilation in combination with positive end-expiratory pressure (with or without recruitment maneuver) decreases postoperative pulmonary complications,reduces peak pressure and improves oxygenation for surgery in the prone position.

Objective To compare the accuracy of somatosensory evoked potentials(SSEPs), motor evoked potentials(MEPs), regional cerebral oxygen saturation(rSO2)and multimodal monitoring in monitoring cerebral ischemia in patients undergoing carotid endarterectomy(CEA). Methods Eighty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 46-76 yr, scheduled for elective CEA, were enrolled in the study. SSEPs, MEPs and rSO2were monitored during CEA. The event of intraoperative cerebral ischemia was defined as:(1)SSEP escape latency prolongation of 10% and∕or amplitude decrease of 50%;(2)disappearance of MEP amplitude;(3)decrease in rSO2>20% of the baseline value;(4)When multimodal monitoring was applied, the event of intraopera-tive cerebral ischemia could be defined as long as one variable previously described met the condition. The gold standard of perioperative cerebral ischemia was defined as:(1)the National Institutes of Health Stroke Scale score≥4 at 1, 3 and 5 days after operation than before operation was considered as neurologi-cal dysfunction;(2)cranial CT showed a new ipsilateral cerebral focal ischemia, and postoperative in-tracranial hemorrhage diseases were excluded. Results Five cases developed cerebral ischemia after opera-tion. The sensitivity and specificity of SSEPs in predicting cerebral ischemia were 80% and 83%, respec-tively;MEPs 80% and 80%, respectively; SSEPs+MEPs 100% and 79%, respectively; rSO260% and 93%, respectively;SSEPs+MEPs+rSO2100% and 7%, respectively. Decrease in rSO2> 20% of the base-line value was consistent with SSEP escape latency prolongation of 10% and∕or amplitude decrease of 50%in diagnosis of cerebral ischemia(Kappa value 0.67, P<0.01); decrease in rSO2>20% of the baseline value was consistent with disappearance of MEP amplitude in diagnosis of cerebral ischemia(Kappa value 0.54, P<0.01). Conclusion rSO2has a good agreement with SSEPs and MEPs in diagnosis of cerebral ischemia during CEA; combination of SSEPs and MEPs produces better accuracy in monitoring cerebral is-chemia.

Following the blood pressure, pulse, breathing and body temperature, pain was identified as the fifth vital signs.Postoperative pain of the spine and spinal cord surgery was a neuropathic pain, it was severe and may affect multiple systems of the patients.Therefore, postoperative analgesia of spine and spinal cord surgery is very important.