Objective:To investigate the influencing factors for early tumor recurrence and the efficacy of adjuvant chemotherapy in gallbladder carcinoma (GBC) patients after curative-intent resection.Methods:The retrospective case-control study was conducted. The clinicopathological data of 506 patients with GBC in 11 medical centers, including The First Affiliated Hospital of Xi'an Jiaotong University et al, from January 2016 to December 2020 were collected. There were 168 males and 338 females, aged (62±11)years. All patients underwent curative-intent resection of GBC, and they were divided into patients with and without early recurrence based on time to postoperative recurrence. Observation indicators: (1) treatment; (2) follow-up and survival of patients; (3) analysis of influencing factors for early tumor recurrence after curative-intent resection of GBC; (4) efficacy of postoperative adjuvant chemotherapy. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data was conducted using the Mann-Whitney U test. Univariate analysis was conducted using the corresponding statistical methods based on data type. Multivariate analysis was conducted using the Logistic regression model with forward method. The Kaplan-Meier method was used to draw survival curve and calculate survival rate, and Log-Rank test was used for survival analysis. Results:(1) Treatment. Of 506 patients, there were 112 cases with postoperative adjuvant chemotherapy, and 394 cases without postopera-tive adjuvant chemotherapy. They underwent 5(range, 3-9)cycles of postoperative adjuvant chemo-therapy. (2) Follow-up and survival of patients. All 506 patients underwent postoperative follow-up, with the follow-up time of 55(range, 34-93)months. During the follow-up, there were 248 patients with tumor recurrence, including 158 cases of early recurrence and 90 cases of late recurrence, and there were 258 patients without tumor recurrence. Of 506 patients, 275 cases survived, and 231 cases died of multiple organ failure caused by tumor recurrence and metastasis. The postoperative recurr-ence-free survival time, overall survival time were 52(range,1-93)months, 62(range, 2-93)months. The 1-, 3-, 5-year disease-free survival rates and 1-, 3-, 5-year overall survival rates of the 506 pati-ents were 68.8%, 53.8%, 47.9% and 78.3%, 58.7%, 51.6%, respectively. Results of survival analysis showed that the median overall survival time of 158 patients with postoperative early recurrence and 348 patients without postoperative early recurrence (including 90 cases of late recurrence and 258 cases of no tumor recurrence) were 9(range, 2-73)months and unreached, showing a significant difference between them ( χ2=456.15, P<0.05). (3) Analysis of influencing factors for early tumor recurrence after curative-intent resection of GBC. Results of multivariate analysis showed that carcinoembryonic antigen (CEA) >5.0 μg/L, poorly differentiated tumor, liver invasion, and tumor N staging as stage N1-N2 were independent risk factors influencing early tumor recurrence after cura-tive-intent resection of GBC ( odds ratio=2.74, 6.20, 1.81, 2.93, 4.82, 95% confidence interval as 1.62-4.64, 1.82-21.12, 1.15-3.08, 1.68-5.09, 1.91-12.18, P<0.05), while postoperative adjuvant chemo-therapy was an independent protect factor ( odds ratio=0.39, 95% confidence interval as 0.21-0.71, P<0.05). (4) Efficacy of postoperative adjuvant chemotherapy. The median overall survival time of 394 patients without postoperative adjuvant chemotherapy and 112 patients with postoperative adjuvant chemotherapy were 57(range, 2-93)months and unreached, showing a significant differ-ence between them ( χ2=9.38, P<0.05). Of the 158 patients with postoperative early recurrence after curative-intent resection of GBC, 135 cases didn't receive adjuvant chemotherapy and 23 cases received adjuvant chemotherapy, with the overall survival time of 8(range, 2-73)months and 17(range, 8-61)months, respectively, showing a significant difference between them ( χ2=7.68, P<0.05). Conclusions:CEA >5.0 μg/L, poorly differentiated tumor, liver invasion, and tumor N staging as stage N1-N2 are independent risk factors influencing early tumor recurrence after curative-intent resection of GBC, while postoperative adjuvant chemotherapy is an independent protect factor. Postoperative adjuvant chemotherapy can prolong the overall survival time of patients with post-operative tumor early recurrence.

BACKGROUND: No convincing modalities have been shown to completely prevent postdural puncture headache (PDPH) after accidental dural puncture (ADP) during obstetric epidural procedures. We aimed to evaluate the role of epidural administration of hydroxyethyl starch (HES) in preventing PDPH following ADP, regarding the prophylactic efficacy and side effects. METHODS: Between January 2019 and February 2021, patients with a recognized ADP during epidural procedures for labor or cesarean delivery were retrospectively reviewed to evaluate the prophylactic strategies for the development of PDPH at a single tertiary hospital. The development of PDPH, severity and duration of headache, adverse events associated with prophylactic strategies, and hospital length of stay postpartum were reported. RESULTS: A total of 105 patients experiencing ADP received a re-sited epidural catheter. For PDPH prophylaxis, 46 patients solely received epidural analgesia, 25 patients were administered epidural HES on epidural analgesia, and 34 patients received two doses of epidural HES on and after epidural analgesia, respectively. A significant difference was observed in the incidence of PDPH across the groups (epidural analgesia alone, 31 [67.4%]; HES-Epidural analgesia, ten [40.0%]; HES-Epidural analgesia-HES, five [14.7%]; P <0.001). No neurologic deficits, including paresthesias and motor deficits related to prophylactic strategies, were reported from at least 2 months to up to more than 2 years after delivery. An overall backache rate related to HES administration was 10%. The multivariable regression analysis revealed that the HES-Epidural analgesia-HES strategy was significantly associated with reduced risk of PDPH following ADP (OR = 0.030, 95% confidence interval: 0.006-0.143; P < 0.001). CONCLUSIONS The incorporated prophylactic strategy was associated with a great decrease in the risk of PDPH following obstetric ADP. This strategy consisted of re-siting an epidural catheter with continuous epidural analgesia and two doses of epidural HES, respectively, on and after epidural analgesia. The efficacy and safety profiles of this strategy have to be investigated further.
Pregnancy ; Female ; Humans ; Post-Dural Puncture Headache/epidemiology* ; Anesthesia, Obstetrical/adverse effects* ; Retrospective Studies ; Punctures ; Starch ; Blood Patch, Epidural

Objective:To evaluate the effects of the second generation laryngeal mask airway (LMA) under general anesthesia on maternal and neonatal outcomes in cesarean delivery.Methods:This study retrospectively enrolled 544 patients who underwent cesarean delivery under general anesthesia with airway intervention in Peking University First Hospital between January 2015 and December 2019. Patients were divided into endotracheal tube group (ETT group, n=379) and LMA group (Supreme TM LMA, n=165) according to the airway devices used under general anesthesia. Propensity score matching was carried out using a multivariable logistic regression model and 133 cases of singleton pregnancies were matched in each group. The main outcome was the incidence of neonatal asphyxia at one minute after birth (1 min Apgar score ≤7). The secondary neonatal outcomes were the incidence of severe asphyxia at one minute after birth (1 min Apgar score ≤3) and asphyxia at five minutes after birth (5 min Apgar score ≤7) and the percentage of neonates transferred to neonatal intensive care unit. The secondary maternal outcomes included the incidence of regurgitation, aspiration and hypoxemia, the percentage transferred to intensive care unit, post-operation all-cause morbidity and fatality before discharge. Two independent samples t-test, Mann-Whitney U test and Chi-square test were used for statistical analysis. Results:Two of the 544 (0.4%) patients had difficulty in intubation and one of them was successfully ventilated with LMA after failed intubation. No regurgitation, aspiration or anesthesia-related death was reported. After the propensity score matching, the incidence of neonatal asphyxia at one minute after birth in the LMA group and the ETT group had no significant difference [15.8% (21/133) vs 19.5% (26/133), χ2=0.646, P=0.422]. Moreover, there were no differences between the LMA and ETT group regarding the incidence of severe asphyxia at one minute after birth [2.3% (3/133) vs 3.0% (4/133), χ2<0.001, P>0.999] or asphyxia at five minutes after birth [4.5% (6/133) vs 4.5% (6/133), χ2<0.001, P>0.999], neonatal intensive care unit admission [27.8% (37/133) vs 38.3% (51/133), χ2=3.328, P=0.068], maternal hypoxemia during the operation [1.5% (2/133) vs 4.5% (6/133), χ2=1.160, P=0.281], maternal intensive care unit admission [3.8% (5/133) vs 9.0% (12/133), χ2=3.079, P=0.079] or post-operation all-cause morbidity [2.3% (3/133) vs 2.3% (3/133), χ2=0.171, P=0.680]. Conclusions:Like tracheal intubation, the second generation LMA (Supreme TM) can be used in cesarean section under general anesthesia without increasing the risk of adverse maternal and neonatal outcomes.

Objective:To investigate the value of combined detection of biomarkers in early diagnosis and prognosis of patients with septic myocardial injury.Methods:The clinical data of 103 patients with sepsis admitted to the intensive care unit (ICU) of the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology from October 2018 to January 2021 were enrolled. According to the cardiac troponin I (cTnI) at admission of ICU, they were divided into septic myocardial injury group (cTnI ≥ 0.15 μg/L) and non-septic myocardial injury group (cTnI < 0.15 μg/L). The serum levels of heart-type fatty acid-binding protein (H-FABP), procalcitonin (PCT), C-reactive protein (CRP), MB isoenzyme of creatine kinase (CK-MB), cTnI and N-terminal pro-brain natriuretic peptide (NT-proBNP) within 6 hours after ICU admission and the worst value of acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score within 24 hours after ICU admission in 103 patients was recorded as well as the 28-day prognosis of patient with septic myocardial injury. Spearman correlation analysis was used to analyze the correlation of each index; receiver operating characteristic curve (ROC curve) was drawn, and the area under ROC curve (AUC) was calculated to analyze the early diagnosis and prognostic value of each index and APACHEⅡ score alone or combined detection in patients with septic myocardial injury.Results:① Among 103 patients with sepsis, 58 patients were complicated with myocardial injury and 45 patients were not complicated with myocardial injury. The serum levels of PCT, CRP, NT-proBNP, CK-MB, cTnI, H-FABP and APACHEⅡ score in patients with septic myocardial injury were significantly higher than those in patients without septic myocardial injury [PCT (μg/L): 3.46±1.35 vs. 1.89±0.43, CRP (mg/L): 81.1±26.8 vs. 65.3±19.1, NT-proBNP (U/L): 8 261.4±2 346.9 vs. 6 120.2±1 809.6, CK-MB (U/L): 15.89±6.25 vs. 12.14±4.24, cTnI (μg/L): 1.50 (0.91, 2.21) vs. 0.18 (0.16, 0.19), H-FABP (μg/L): 26.45±8.24 vs. 12.82±5.73, APACHEⅡ score: 24.0 (18.0, 29.0) vs. 16.0 (14.0, 18.0), all P < 0.01]. Spearman correlation analysis showed that PCT, CRP and APACHEⅡ scores were positively correlated with NT-proBNP, CK-MB, cTnI and H-FABP. ROC curve analysis showed that H-FABP in the diagnosis of septic myocardial injury (AUC = 0.916) was superior to NT-proBNP (AUC = 0.756) and CK-MB (AUC = 0.675); the AUC of NT-proBNP and CK-MB combined with H-FABP was 0.921, the sensitivity was 82.1%, and the specificity was 88.2%.② Twenty-three patients survived in 28 days, and 35 died. The levels of serum PCT, CRP, NT-proBNP, CK-MB, cTnI, H-FABP and APACHEⅡ score in death group were significantly higher than those in survival group [PCT (μg/L): 3.86±1.27 vs. 2.84±1.24, CRP (mg/L): 92.3 (65.0, 101.7) vs. 74.3 (65.7, 79.8), NT-proBNP (ng/L): 9 106.4±2 013.9 vs. 6 975.5±2 266.7, CK-MB (U/L): 17.90±6.49 vs. 12.82±4.46, cTnI (μg/L): 2.11±0.86 vs. 1.12±0.44, H-FABP (μg/L): 30.08±7.90 vs. 20.93±5.14, APACHEⅡ score: 25.0 (20.0, 30.0) vs. 19.0 (17.0, 24.0), all P < 0.01]. ROC curve analysis showed that H-FABP in evaluating 28-day death of patients with septic myocardial injury (AUC = 0.839) was superior to PCT (AUC = 0.707), CRP (AUC = 0.716), NT-proBNP (AUC = 0.761), CK-MB (AUC = 0.733), cTnI (AUC = 0.824) and APACHEⅡ score (AUC = 0.724); the AUC of NT-proBNP and cTnI combined with H-FABP was 0.888, the sensitivity was 91.4%, and the specificity was 82.6%. Conclusions:H-FABP plays an important role in the early diagnosis and prognosis of septic myocardial injury. Early combined detection of NT-proBNP, CK-MB and H-FABP can significantly improve the diagnostic ability of septic myocardial injury, and NT-proBNP and cTnI combined with H-FABP can significantly improve the ability to predict the adverse prognosis of sepsis myocardial injury.

Enhanced recovery after surgery (ERAS) refers to an evidence-based, multidisciplinary approach to reduce postoperative surgical trauma, stress response, and complications, thereby improving recovery and shortening hospital stay. In December 2018 and September 2019, the American Journal of Obstetrics and Gynecology has published ERAS guidelines for perioperative care in cesarean delivery, consisting of three parts: preoperative, intraoperative, and postoperative phases, including elective and emergent cesarean section pathways. The guidelines focused on perioperative maternal care and immediate neonatal care, aiming to enhance cesarean delivery's quality and safety and improve maternal and neonatal outcomes. This article interprets the central part of the guideline.

Objective To investigate the clinical efficacies of free endoscopic nasobiliary drainage (ENBD) in primary duct closure (PDC) following laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis.Methods The retrospective cohort study was conducted.The clinical data of 312 patients with extrahepatic bile duct stones accompanied with or without cholecystolithiasis who were admitted to the 11 medical centers [86 in the Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,62 in the Second Affiliated Hospital of Zhejiang University School of Medicine,44 in the West China Hospital of Sichuan University,29 in the First Affiliated Hospital of Xi'an Jiaotong University,27 in the First Hospital Affiliated to Army Medical University (Third Military Medical University),25 in the Hunan Provincial People's Hospital,17 in the Beijing Friendship Hospital of Capital Medical University,10 in the First Affiliated Hospital of Hainan Medical University,5 in the Henan Provincial People's Hospital,4 in the Beijing Tian Tan Hospital of Capital Medical University,3 in the First Affiliated Hospital of Fujian Medical University] from January 2011 to June 2017 were collected.All patients underwent LCBDE+PDC,and 81 and 231 patients with and without ENBD were respectively allocated into the ENBD group and PDC group.Observation indicators:(1) comparisons of operation situations;(2) comparisons of postoperative recovery;(3) comparisons of postoperative complications;(4) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative complications up to June 2017.Measurement data with normal distribution were represented as x±s.Comparison between groups was analyzed by the t test.Measurement data with skewed distribution were represented M [interquartile range (IQR)],and comparison between groups was analyzed by the nonparametic test.Comparisons of count data were analyzed using the chi-square test and Fisher exact probability.Results (1) Comparisons of operation situations:all the 312 patients underwent successful laparoscopic LCBDE + PDC,without conversion to open surgery,including postoperative death of 1 patient in the PDC group.The common bile duct diameter,cases using interrupted sutures,continuous sutures,absorbable threads and nonabsorbable threads were respectively (1.2±0.4)cm,106,125,195,36 in the PDC group and (1.1±0.5)cm,76,5,79,2 in the ENBD group,with statistically significant differences between groups (t =2.497,x2 =56.706,8.457,P＜0.05).The numbers of stones,stone diameter,cases with common bile duct wall (≤ 3 mm and ＞3 mm),normal and abnormal Oddi sphincter contraction function,volume of intraoperative blood loss and operation time were respectively 2.1±1.7,(1.1-±0.6)cm,148,83,226,5,20 mL (10-45 mL),(116± 49)minutes in the PDC group and 1.9±1.6,(1.0±0.6)cm,49,32,75,6,20 mL (15-30 mL),(113± 23)minutes in the ENBD group,with no statistically significant difference between groups (t =1.021,0.329,x2 =0.329,3.428,Z=1.147,t=0.521,P＞0.05).The further analysis:of 312 patients,cases and time using interrupted sutures and continuous sutures were respectively 182,130 and (133±.49) minutes,(103±34) minutes,with a statistically significant difference between groups (t =-6.605,P＜0.05).The volume of intraoperative blood loss and cases with postoperative complications using interrupted sutures and continuous sutures were respectively 20 mL (15-31 mL),21 and 20 mL (10-45 mL),18,with no statistically significant difference between groups (Z =-0.285,x2 =0.369,P＞ 0.05).Of 312 patients,cases,operation time,volume of intraoperative blood loss and postoperative complications using absorbable threads and non-absorbable threads were respectively 274,(116±44)minutes,20 mL (15-40 mL),33 and 38,(115±35) minutes,18 mL (10-26 mL),6,with no statistically significant difference between groups (Z =0.971,t =0.023,x2 =0.154,P＞ 0.05).(2) Comparisons of postoperative recovery:recovery time of gastrointestinal function,time of abdominal drainage-tube removal,using time of antibiotics and duration of hospital stay were respectively (2.0± 1.5) days,(4.0 ± 2.4) days,(4.0±2.8) days,(5.5±3.0) days in the PDC group and (4.0±1.9) days,(6.9±3.5) days,(10.0± 3.9) days,(11.1±3.7)days in the ENBD group,with statistically significant differences between groups (t =-9.507,-8.258,-15.103,-13.575,P＜0.05).The total expenses of hospital stay in the Affiliated Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology were respectively (5.1 ±0.6)× 104 yuan in the PDC group and (6.5-±0.5)× 104 yuan in the ENBD group,with a statistically significant difference between groups (t =-9.516,P＜0.05).(3) Comparisons of postoperative complications:incidence of complications in the PDC group was 14.29％ (33/231),including 16 with biliary fistula,11 with biliary tract infection,3 with wound infection,1 with biliary tract bleeding,1 with residual stones of common bile duct and 1 with death;incidence of complications in the ENBD group was 6.17％ (5/81),including 2 with biliary fistula,2 with biliary tract infection and 1 with biliary tract bleeding,showing no statistically significant difference between groups (x2 =3.151,P＞0.05).(4) Follow-up situations:of 312 patients,252 were followed up for 2-67 month,with a median time of 15 months,including 175 in the PDC group and 77 in the ENBD group.During the follow up,there was no occurrence of jaundice,cholangitis and pancreatitis,and stone recurrence and postoperative cholangiostenosis were not detected by abdominal color Doppler ultrasound or CT or magnetic resonanced cholangio-pancreatography.Conclusion On the basis of grasping operative indication strictly,ENBD in PDC following LCBDE for choledocholithiasis is safe and effective.

Objective:To evaluate the effect of intraoperative dexmedetomidine (DEX)infusion during propofol intravenous anesthesia on postoperative recovery after major spinal surgery.Methods:Sixty pa-tients aged 1 8 to 65 (American Society of Anesthesiologists,ASA Ⅰ -Ⅱ),scheduled for spinal surgery from January 201 4 to May 201 4 were randomized into two groups.The DEX group (n =30)received 0.5 μg/kg of DEX ten minutes before anesthesic induction,followed by an infusion of DEX at 0.2 μg/(kg·h)intraoperatively and the control group (n =30)was given identical amounts of normal saline. At the end of surgery,the patients of both groups received patient-controlled intravenous analgesia (PCIA)with morphine 0.5 mg/h (1 mg demand dose and 8 min lockout).Heart rate and mean arterial pressure (MAP) were continually monitored during operation and in the post-anesthesia care unit (PACU).The propofol and sufentanil consumptions during operation and the morphine consumption 48 h after surgery were recorded.The time for recovery and extubation were recorded.The followed-up evalua-tions were performed to assess Ramsay scores,visual analogue scale (VAS)pain scores as well as side effects in PACU and 48 h after surgery.Results:Heart rate of DEX group was lower than that of control group after intubation and extubation and in PACU 1 0 min (P <0.05).MAP was lower in DEX group than that in control group after extubation and in PACU (P <0.05).Compared with control group,the propofol consumption during anesthesic induction,the sufentanil consumption during operation and the cumulative consumption of morphine 2 h and 6 h after surgery were decreased (P <0.05).There were no differences between the two groups as to the time for recovery or extubation.Compared with control group,the VAS pain scores were significantly decreased (P <0.01 ),the incidence of postoperative nau-sea and vomiting in DEX group were significantly decreased (P <0.05)48 h after surgery.Conclusion:Intraoperative infusion of DEX improved quality of recovery,provided good analgesia,and decreased morphine use and the incidence of postoperative nausea and vomiting after major spinal surgery.

Among 13 331 parturients from January 2011 to December 2013 in Peking University First Hospital, 6 162 cases required cesarean section, and the rate of cesarean section was 46.223％.The constituent ratio of cesarean section under general anesthesia was 1.75％, the constituent ratio of emergency cesarean section under general anesthesia was 60.2％, and the constituent ratio of the critically ill patients of ASA physical status ≥ Ⅲ was 16.7％.The main indication for general anesthesia was contraindication to neuraxial anesthesia or failure of neuraxial anesthesia.Of the 108 parturients who underwent cesarean section under general anesthesia, 33 cases were in laryngeal mask airway (LMA) group and 75 cases in intubation group.There was no statistically significant difference between intubation group and LMA group in terms of general data, emergency rate, percentage of patients or neonates admitted to intensive care unit, and neonatal Apgar score (P＞0.05).There were no airway-related complications such as difficult airway, aspiration or regurgitation in either group.In summary, general anesthesia was mainly suitable for cesarean section contraindicating neuraxial anesthesia and failed cesarean section, and the proportion of emergency operations was higher;LMA could be used for airway management in cesarean section under general anesthesia, but it must be placed correctly ensuring good airway sealing to prevent aspiration.

We introduced Case based learning into traditional bilingual teaching, dividing the hepatobiliary surgery teaching into four phases: preview, introduction, group discussion and estimation after class . Through the classroom organization analysis of common cases of liver and gallbladder surgery, we took students as the main body, teacher as the guide, to complete the bilingual teaching. Auxiliary case based learning used in bilingual teaching of liver and gallbladder surgery practice is beneficial to improving the quality of bilingual teaching, and helps to cultivate the students' clinical thinking. However, there are still some deficiencies of the case aided bilingual teaching, which needs continuous improvement.

Objective To evaluate the effects of different storage periods at room temperature on domestic cisatracurium-induced neuromuscular (N-M) block.Methods One hundred and twenty ASA Ⅰ or Ⅱ patients,aged 18-64 yr,scheduled for elective operations under general anesthesia,were randomly divided into 3 groups (n =40 each):cisatracurium stored for 60 days at 4-8 ℃ group (group LT),cisatracurium stored for 30 days at room temperature group (group RT30) and cisatracurium stored for 60 days at room temperature group (group RT60).Anesthesia was induced with iv injection of midazolam and target-controlled infusion of propofol (target plasma concentration 3 μg/ml) and remifentanil (target effect-site concentration 3-5 ng/ml).A bolus of cisatracurium 0.2 mg/kg was given intravenously over 5-10 s as soon as the patients lost consciousness.N-M block was monitored with TOF-Watch SX (Organon,Netherlands).Single stimulation was applied to the ulnar nerve at wrist.The maximal degree of N-M block,onset time,clinical duration,recovery index and 75 ％ recovery time were recorded.The patients were intubated and mechanically ventilated when N-M block reached the maximal degree.The intubation condition was evaluated.Hypotension,bradycardia and skin allergy were recoded.Results Compared with group LT,no significant change was found in the onset time,clinical duration,recovery index and 75％ recovery time in group RT30 (P ＞ 0.05),and the onset time was significantly prolonged,clinical duration and 75％ recovery time were shortened in group RT60 (P ＜ 0.05).The onset time was significantly longer and clinical duration was shorter in group RT60 than in group RT30 (P ＜ 0.05).The intubation condition was excellent or good in the three groups and there was no significant difference among the three groups.There was no significant difference in the incidence of hypotension and bradycardia among the three groups (P ＞ 0.05).No patients developed skin allergy.The maximal degree of N-M block was 100％ in groups LT,RT30 and RT60 except one case with 95％ in group RT60.Conclusion No significant change is found in the N-M block induced by domestic cistracurium when stored for 30 days at room temperature,however,the N-M block is significantly attenuated when stored for 60 days at room temperature.