Malignant hyperthermia(MH)is a rare perioperative disease with autosomal dominant inheritance,and its pathogenesis involves specific gene mutations.Its clinical feature is that conventional anesthetics can trigger abnormally high metabolic reactions in skeletal muscles.Although the incidence of this disease is low,the condition is dangerous,progresses rapidly,and has a high mortality rate;Its treatment relies on early diagnosis,timely application of the specific drug Dantrolene Sodium,and rapid and orderly comprehensive symptomatic supportive treatment.MH is a critical perioperative emergency that can occur during surgery.It presents with symptoms such as hyperpyrexia,metabolic acidosis,rhabdomyolysis,and dysfunction of multiple organ systems.If not treated promptly,it can quickly lead to life-threatening arrhythmias and cardiac arrest.This condition serves as an essential teaching example in anesthesia crisis resource management.As an effective teaching method,scenario simulation exercises can comprehensively enhance medical staff's personal technical,non-technical,and teamwork abilities through simulating emergency scenarios,teaching assessments,and retrospective discussions,especially suitable for comprehensive management training of fatal diseases.Many countries internationally have incorporated simulation exercises for MH into their routine teaching and training systems.The effectiveness of teaching and training for anesthesiologists in MH and their ability to handle anesthesia crisis events have been continuously improved through a periodic training model.This article systematically reviews the research progress and practical experience of scenario simulation exercises in emergency training for MH,with a focus on exploring how to establish a scenario simulation exercise plan for emergency application and comprehensive symptomatic support treatment of Dantrolene Sodium based on the actual situation in China,providing reference for improving the teaching and training quality of MH and other clinical crisis events.

Objective To explore the influence factors of hemorrhagic transformation in the First People's Hospital of Lianyungang in patients with acute anterior circulation ischemic stroke(AIS)after mechanical thrombectomy(MT).Methods We collected the clin-ical data of 354 AIS patients who underwent MT in the Affiliated Lianyungang Hospital of Xuzhou Medical University from January 2019 to December 2023.They were grouped according to the results of cranial CT reviewed in 24-72h after the MT,and the patients who under-went HT were the HT group,with a total of 208 patients,and the patients who did not have HT were the control group,with a total of 104 patients.The clinical differences between the two groups were compared.Measurement data were analyzed using the Mann-Whitney U test,count data were analyzed using the x2 test,and multivariate Logistic regression analysis was used to identify independent risk factors.Results Compared to control group,the patients of HT group were older,had a higher prevalence of atrial fibrillation,higher preopera-tive NIHSS scores,lower platelet counts,higher glycated hemoglobin levels,and a higher proportion of preoperative thrombolytic therapy(P＜0.05).Multivariate logistic regression analysis indicated that hemoglobin(OR=1.02,95％CI:1.01-1.03,P=0.006)and glycated hemoglobin(OR=1.24,95％CI:1.09-1.40,P＜0.001)were independent influence factors for HT.Platelet count(OR=0.99,95％CI:0.99-0.99,P=0.014)was identified as a protective factor against HT.Conclusion Preoperative hemoglo-bin,glycated hemoglobin,and platelet count are all associated with HT following MT.

Objective To explore the influence factors of hemorrhagic transformation in the First People's Hospital of Lianyungang in patients with acute anterior circulation ischemic stroke(AIS)after mechanical thrombectomy(MT).Methods We collected the clin-ical data of 354 AIS patients who underwent MT in the Affiliated Lianyungang Hospital of Xuzhou Medical University from January 2019 to December 2023.They were grouped according to the results of cranial CT reviewed in 24-72h after the MT,and the patients who under-went HT were the HT group,with a total of 208 patients,and the patients who did not have HT were the control group,with a total of 104 patients.The clinical differences between the two groups were compared.Measurement data were analyzed using the Mann-Whitney U test,count data were analyzed using the x2 test,and multivariate Logistic regression analysis was used to identify independent risk factors.Results Compared to control group,the patients of HT group were older,had a higher prevalence of atrial fibrillation,higher preopera-tive NIHSS scores,lower platelet counts,higher glycated hemoglobin levels,and a higher proportion of preoperative thrombolytic therapy(P＜0.05).Multivariate logistic regression analysis indicated that hemoglobin(OR=1.02,95％CI:1.01-1.03,P=0.006)and glycated hemoglobin(OR=1.24,95％CI:1.09-1.40,P＜0.001)were independent influence factors for HT.Platelet count(OR=0.99,95％CI:0.99-0.99,P=0.014)was identified as a protective factor against HT.Conclusion Preoperative hemoglo-bin,glycated hemoglobin,and platelet count are all associated with HT following MT.

Malignant hyperthermia(MH)is a rare perioperative disease with autosomal dominant inheritance,and its pathogenesis involves specific gene mutations.Its clinical feature is that conventional anesthetics can trigger abnormally high metabolic reactions in skeletal muscles.Although the incidence of this disease is low,the condition is dangerous,progresses rapidly,and has a high mortality rate;Its treatment relies on early diagnosis,timely application of the specific drug Dantrolene Sodium,and rapid and orderly comprehensive symptomatic supportive treatment.MH is a critical perioperative emergency that can occur during surgery.It presents with symptoms such as hyperpyrexia,metabolic acidosis,rhabdomyolysis,and dysfunction of multiple organ systems.If not treated promptly,it can quickly lead to life-threatening arrhythmias and cardiac arrest.This condition serves as an essential teaching example in anesthesia crisis resource management.As an effective teaching method,scenario simulation exercises can comprehensively enhance medical staff's personal technical,non-technical,and teamwork abilities through simulating emergency scenarios,teaching assessments,and retrospective discussions,especially suitable for comprehensive management training of fatal diseases.Many countries internationally have incorporated simulation exercises for MH into their routine teaching and training systems.The effectiveness of teaching and training for anesthesiologists in MH and their ability to handle anesthesia crisis events have been continuously improved through a periodic training model.This article systematically reviews the research progress and practical experience of scenario simulation exercises in emergency training for MH,with a focus on exploring how to establish a scenario simulation exercise plan for emergency application and comprehensive symptomatic support treatment of Dantrolene Sodium based on the actual situation in China,providing reference for improving the teaching and training quality of MH and other clinical crisis events.

The damage caused by space microgravity environment to the body systems of astronauts directly affects their work efficiency.This paper reviewed previous studies on the effects of space microgravity environment and ground simulated microgravity environment on cognition and emotion, potential mechanisms and interventions. It was found that a microgravity environment led to dysfunction in learning, memory, spatial orientation and other aspects, and caused anxiety and depression. The mechanisms of cognitive and emotional impairment associated with microgravity environment are complex, including neuronal damage, brain structure changes, neurotransmitter disorders, synaptic dysfunction, oxidative stress injury, and energy metabolism disorders. Pharmacological approaches such as natural extracts, physical interventions such as repetitive transcranial magnetic stimulation, and new therapies such as probiotics were expected to reduce cognitive impairment and mood disorders caused by microgravity exposure. With the development of aerospace medicine in China, the potential mechanism and interventions of microgravity environment on cognitive and emotional impairment remain to be further studied.

Objective:To investigate and analyze the awareness of malignant hyperthermia (MH) in anesthesiology nurses in mainland China.Methods:From November 2021 to January 2022, anesthesiology nurses of secondary hospitals or above in Chinese mainland were enrolled by convenience sampling and investigated by a self-designed questionnaire on the awareness of MH.The system automatically recorded the situation of questionnaires.Results:A total of 2 058 anesthesiology nurses participated in the survey, distributed in 21 provinces, 2 autonomous regions (Ningxia Hui Autonomous Region, Guangxi Zhuang Autonomous Region) and 4 municipalities directly under the central government, and 2 049 questionnaires were effectively received with effective recovery of 99.56%.The correct answers to questions related to the treatment of MH, characteristics of the disease, classification, susceptible population, screening method of the susceptible population, genetic mode, inducing factors, the first symptoms and the best infusion time of dantrolene, preparation method of domestic dantrolene and the first dose were 86.58%, 82.33%, 58.18%, 50.90%, 50.76%, 50.42%, 45.73%, 32.89%, 51.25%, 48.32% and 46.51%, respectively.Only 27.13% of anesthesiology nurses expressed that dantrolene was available in their hospital.The scores of knowledge about MH among anesthesiology nurses in hospitals of province-level municipalities and provincial capital cities were significantly higher than those in other cities ( P<0.001). The scores of knowledge about MH among the anesthesiology nurses in secondary hospitals were significantly higher than those in tertiary hospitals ( P<0.05). There was no significant difference in the scores of knowledge about MH among anesthesiology nurses with different professional titles, educational backgrounds, and working years ( P>0.05). Conclusions:Anesthesiology nurses in mainland China have insufficient awareness of MH.Popularizing the knowledge about MH and strengthening the awareness of MH in medical staff in the department of anesthesiology throughout the country may be of great significance in improving the diagnosis and treatment of MH in China.

Abstract: Objective To analyze the clinical features and the key point of diagnosis of occupational dental erosion Methods (ODE). Three cases of diagnosis data of occupational diseaseof ODE have been collected to analyze retrospectively. Results - Thethreecaseshadaclearhistoryoflong timeexposuretoacidfogand/oranhydride,andtheirworkingyearsranged from 9.5 to 17.4 years. The mainly clinical manifestation was sclerous tissue damage of anterior tooth in above cases. What′s more, abrasion, wear, external injury, enamel hypoplasia, dental fluorosis, dental caries, wedge defect and other diseases of - dentalscleroustissueswereexcluded,andnon ODEduetoacidicfoods,beverages,drugs,andcertaindiseasescanbeexcluded.- Intwoofthreecases,twoormoreanteriorteethwereidentifiedassecondaryortertiaryaciderosionwhichwassuspected ODE, thereforetheyappliedfortheoccupationaldiseasediagnosisafterfivemonths/eightyears,andthentheywerebothdiagnosedas-ODE(gradeⅡ).Theotheronewasfirstdegreedentaletching,includingtwoteethintheanteriordentalarea,whoprocessedthe-ConclusionoccupationaldiseasediagnosistwoweeksafterbeingsuspectedODEandwasdiagnosedasODE(gradeⅠ).The onsetofODE isinsidious,and theinitialsymptomsarenotobvious,which iseasytobeignored.Thediagnosisand differential diagnosisofODEcanbedistinguishedbasedontheoccupationalexposurehistoryofacidfogand/oranhydride,medicalhistory andclinicalfeatures.

A 14-year-old male pediatric patient was admitted to the hospital mainly because of neck and back deformity, with limited activity for 7 yr, dysphagia and short of breath for more than 10 months.He was diagnosed with cervical lordosis deformity, RyR1 gene-related myopathy, high possibility of multi-minicore disease and being susceptible to malignant hyperthermia.Posterior cervical orthopedic internal fixation surgery was successfully performed under total intravenous anesthesia with propofol.The vital signs were stable during anesthesia and operation which lasted for 10 h. The patient was admitted to intensive care unit after the uneventful operation.When emerging from general anesthesia, the patient suddenly presented with symptoms of muscular fasciculation in the head, face, trunk and limbs, along with elevated body temperature as high as 39.4℃, severe acidosis and hypercapnia, meanwhile, the blood creatine kinase, blood myoglobin and urinary myoglobin gradually increased.The patient was diagnosed with malignant hyperthermia based on the clinical grading scale score of 63.Dantrolene sodium was infused intravenously, combined with multiple treatments such as physical cooling, correction of acidosis and electrolyte disturbance, alkalization of urine, intermittent hemofiltration and plasma exchange.The arrhythmia and delirium were treated symptomatically.The pediatric patient was fully recovered and discharged with good outcomes.

The original version of this article unfortunately contained some mistakes.

OBJECTIVETo investigate the effects of initiative and passive perioperative function exercises on hidden blood loss (HBL).

METHODSTwo hundreds and thirty elderly patients with hip fractures aging from 67 to 87 years (average age of 73.6 years) who underwent total hip replacement were included. By the intensity and the manner of perioperative function exercises, patients were divided into four groups: little initiative function exercises group (group A, n=51), little initiative and passive function exercises group (group B, n=54), normal initiative function exercises group (group C, n=65), normal initiative and passive function exercises group (group D, n=60). The true total blood loss, HBL and their proportion on the original blood volume and total blood loss was calculated depending on height, weight, intra-operative blood loss, post-operative blood loss, pre- and post-operative hematocrit, and blood transfused. According to the proportion of mean HBL on total blood loss, patients were divided into low HBL group and high HBL group. The data were analyzed by t test.

RESULTSThe mean HBL was 517 ml, 41.9% of the total blood loss. Thereinto, the mean HBL was 695 ml in group A, 49.3% of the total blood loss, the prevalence of high HBL was 66.7% (34/51); the mean HBL was 625 ml in group B, 46.9% of the total blood loss, the prevalence of high HBL was 59.3% (32/54); the mean HBL was 446 ml in group C, 38.4% of the total blood loss, the prevalence of high HBL was 30.8% (20/65); the mean HBL was 346 ml in group D, 32.3% of the total blood loss, the prevalence of high HBL was 20.0% (12/60). Mean HBL, mean HBL/total blood loss, prevalence of high HBL were lower in group C than that in group A and group B (all P<0.05); and were lower in group D than that in group C (all P<0.05). The prevalence was 57.4% (132 cases) in low HBL group, and 42.6% (98 cases) in high HBL. The proportion of little initiative function exercises patients in high HBL group was obviously higher than that in low HBL group (P<0.05).

CONCLUSIONSThe intensity and the manner of perioperative function exercises are strongly associated with the HBL in elderly patients with total hip replacement. The initiative combined with the passive function exercises could be effectively prevent and reduce the incidence of high HBL.

Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; Blood Loss, Surgical ; Exercise Therapy ; adverse effects ; Hip Fractures ; surgery ; Humans ; Postoperative Hemorrhage