The accumulation of fatigue during military operations may lead to decreased operational efficiency and non-combat attrition,which can impact combat effectiveness.On-site monitoring and evaluation of fatigue during military operations,as an important means to keep track of military operations and bring about quick changes in training,underlie the combat effectiveness of military personnel.Focusing on the on-site monitoring and evaluation methods of fatigue during military operations,this paper reviews the determinants of such fatigue as well as on-site monitoring and comprehensive evaluation methods so as to provide reference for accurate and efficient evaluation of fatigue during military operations and for early warning of such fatigue.

Objective:To evaluate the relationship between prognostic nutritional index (PNI) and myocardial injury after non-cardiac surgery (MINS).Methods:This was a retrospective cohort study. The clinical data of adult patients ( n=2 203) who underwent liver resection surgery with general anesthesia at our center from January 2016 to August 2019 were retrospectively collected. The predictive value of preoperative PNI for MINS and the optimal cut-off value of PNI were evaluated and determined according to the receiver operating characteristic curve, and the patients were divided into 2 groups based on the cut-off value: high PNI group and low PNI group. Logistic regression analyses were applied to investigate the relationship between preoperative PNI and MINS. According to the same inclusion and exclusion criteria, the clinical data of patients at our center from January 2022 to December 2023 were collected as the validation set ( n=2 525), and they were grouped using the same PNI cutoff value. Logistic regression analyses were used to verify the relationship between PNI and MINS. Results:The receiver operating characteristic curve analysis showed that the area under the curve of preoperative PNI for predicting MINS was 0.651 (95% confidence interval [ CI] 0.602-0.699), with an optimal cut-off value of 46.193, and the specificity and sensitivity were 0.729 and 0.519 respectively. The integer 46 was considered as the optimal cutoff value for PNI, and the patients were divided into low PNI group (PNI<46, n=606) and high PNI group (PNI≥46, n=1 597). Both univariate and multivariate logistic regression analyses showed that preoperative low PNI was an independent risk factor for the occurrence of MINS (univariate: OR=2.873, 95% CI 2.063-4.003, P<0.001; multivariate: OR=1.844, 95% CI 1.241-2.600, P=0.003). The results in the validation set were still robust (univariate: OR=2.694, 95% CI 1.890-3.833, P<0.001; multivariate: OR=1.602, 95% CI 1.071-2.385, P=0.021). Conclusions:Preoperative low-level PNI is an independent risk factor for MINS, with a certain predictive value.

OBJECTIVE: To explore the regulatory effects of GABAergic neurons in the zona incerta (ZI) on sevoflurane and propofol anesthesia. METHODS: Forty-eight male C57BL/6J mice divided into 8 groups (n=6) were used in this study. In the study of sevoflurane anesthesia, chemogenetic experiment was performed in 2 groups of mice with injection of either adeno-associated virus carrying hM3Dq (hM3Dq group) or a virus carrying only mCherry (mCherry group). The optogenetic experiment was performed in another two groups of mice injected with an adeno-associated virus carrying ChR2 (ChR2 group) or GFP only (GFP group). The same experiments were also performed in mice for studying propofol anesthesia. Chemogenetics or optogenetics were used to induce the activation of GABAergic neurons in the ZI, and their regulatory effects on anesthesia induction and arousal with sevoflurane and propofol were observed; EEG monitoring was used to observe the changes in sevoflurane anesthesia maintenance after activation of the GABAergic neurons. RESULTS: In sevoflurane anesthesia, the induction time of anesthesia was significantly shorter in hM3Dq group than in mCherry group (P < 0.05), and also shorter in ChR2 group than in GFP group (P < 0.01), but no significant difference was found in the awakening time between the two groups in either chemogenetic or optogenetic tests. Similar results were observed in chemogenetic and optogenetic experiments with propofol (P < 0.05 or 0.01). Photogenetic activation of the GABAergic neurons in the ZI did not cause significant changes in EEG spectrum during sevoflurane anesthesia maintenance. CONCLUSION Activation of the GABAergic neurons in the ZI promotes anesthesia induction of sevoflurane and propofol but does not affect anesthesia maintenance or awakening.
Male ; Animals ; Mice ; Mice, Inbred C57BL ; Propofol/pharmacology* ; Sevoflurane/pharmacology* ; Zona Incerta ; Anesthesia, General ; GABAergic Neurons

Objective:To retrospectively review the efficacy of enhanced epidural anesthesia in the patients undergoing cesarean section.Methods:The data from patients who underwent cesarean section in our hospital from August 2008 to December 2021 were retrospectively collected. The method of epidural anesthesia, drug dosage, onset time, blocking level, anesthesia effect, remedial medication, and complications related to the method were recorded. The main points of enhanced epidural anesthesia included: ① test negative pressure by rotating the epidural puncture needle in situ to determine the position of the needle tip; ② catheterization after administering local anesthetic through epidural puncture needle to assess the clinical application of this technique. A questionnaire survey was conducted in 134 anesthesiologists with qualifications for epidural procedures. The questionnaire addressed whether to perform routine needle rotation during epidural procedures, direction of needle rotation, and the percentage of the dosage of local anesthetic administered through puncture needle. Results:A total of 10 054 patients received epidural anesthesia (10 016 cases) and switched to general anesthesia because of poor epidural effect or intraoperative emergencies (38 cases) were enrolled. The consumption of local anesthetics for epidural anesthesia was 18 (15, 20) ml.There were 7 287 cases with block plane records, of which the ratio of the block level reached T 6-8 was 86.84%. The time from the beginning of anesthesia to skin incision was 25 (20, 30) min. Sixteen patients (0.159%) switched to general anesthesia because of poor epidural effect.Among 10 016 patients underwent epidural anesthesia, 925 patients (9.235%) received intravenous adjunctive drugs.No patients experienced total spinal anesthesia, 25 patients (0.248%) had epidural perforation due to puncture or needle rotation, and 4 cases (0.039%) local anesthetic intoxication, 3 cases (0.030%) postoperative nerve injury, and 142 patients (1.412%) requiring intervention with vasoactive drugs due to hemodynamic instability within 30 min after epidural administration. Questionnaire survey: The proportion of anesthesiologists rotating epidural puncture needles was 85.1%, and the proportion of anesthesiologists using epidural puncture needles to inject local anesthesia drugs with a dose greater than 50% of the total dose before catheterization was 84.2%. Conclusions:Enhanced epidural anesthesia can provide effective anesthesia for the patients undergoing cesarean section without increasing the risk of complications related to epidural procedures.

Objective:To explore the effect of desflurane on activity of neurons in 2/3 layer cortex of mice by using high-resolution light-field intelligent imaging system.Methods:Six SPF healthy male Rasgrf/Ai148d mice, aged 8-12 weeks, weighing 25-30 g, were selected. The 6 mice were subjected to skull replacement surgery and then recovered for 2 weeks before experiment.The mice were first fixed under the high-resolution light-field intelligent imaging system for 5 min before calcium signals in 2/3 layer cortex were recorded. The 7.5% desflurane was inhaled for anesthesia starting from 100 s of recording and inhalation was stopped at 700 s, and then the recording continued for 700 s. The total duration of the experiment was 1 500 s. Neurons were extracted and data were analyzed using MATLAB software.Results:When mice were subjected to inhalation anesthesia with desflurane, the calcium fluorescence intensity and percentage of active neurons in the cortex 2/3 layers initially increased significantly, then continuously declined, stabilizing after about 100 s of inhalation. After cessation of inhalation, it gradually recovered to the pre-anesthetic level around 50 s post-inhalation. During the induction period of anesthesia, the percentage of active neurons was significantly higher in the retrosplenial cortex than in the other brain regions ( P<0.05). Conclusions:The disappearance and recovery of consciousness induced by desflurane anesthesia at the neuronal level is not a " symmetrical" process. Neuronal activity in the brain exhibits asymmetry when entering and recovering from an anesthetized state. The retrosplenial cortex, which is related to sleep-wake cycles, may play a crucial role in maintaining consciousness during induction of anesthesia with desflurane.

Dopaminergic neurons in the ventral tegmental area (VTA) play an important role in cognition, emergence from anesthesia, reward, and aversion, and their projection to the cortex is a crucial part of the "bottom-up" ascending activating system. The prelimbic cortex (PrL) is one of the important projection regions of the VTA. However, the roles of dopaminergic neurons in the VTA and the VTA^DA-PrL pathway under sevoflurane anesthesia in rats remain unclear. In this study, we found that intraperitoneal injection and local microinjection of a dopamine D1 receptor agonist (Chloro-APB) into the PrL had an emergence-promoting effect on sevoflurane anesthesia in rats, while injection of a dopamine D1 receptor antagonist (SCH23390) deepened anesthesia. The results of chemogenetics combined with microinjection and optogenetics showed that activating the VTA^DA-PrL pathway prolonged the induction time and shortened the emergence time of anesthesia. These results demonstrate that the dopaminergic system in the VTA has an emergence-promoting effect and that the bottom-up VTA^DA-PrL pathway facilitates emergence from sevoflurane anesthesia.
Anesthesia ; Animals ; Dopaminergic Neurons/metabolism* ; Rats ; Receptors, Dopamine D1/metabolism* ; Sevoflurane/pharmacology* ; Ventral Tegmental Area/metabolism*

Objective:To observe and analyze the changes in activity of layer 2/3 cortical neurons in isoflurane-anesthetized mice by Real-time Ultra-large-Scale High-resolution (RUSH) imaging platform.Methods:Clean-grade healthy male Rasgrf2-Cre/Ai148d mice, aged 8-12 weeks, weighing 18-25 g, were studied.The mice recovered ten days after the skull replacement surgery and proceeded to the next experiment.Imaging data of calcium fluorescence signals from layer 2/3 cortical neurons were acquired by RUSH imaging platform after fixing the head of mice.The time of imaging data acquisition in the awake state, during anesthesia with 1.2% isoflurane, and after the end of anesthesia was 100, 600 and 600 s, respectively.Imaging data were analyzed using Image J and MATLAB softwares.Results:The overall trend of activity of layer 2/3 cortical neurons decreased first and then stabilized with the inhalation of 1.2% isoflurane.The cortical neural activity were gradually increased when isoflurane inhalation was stopped.The recovery rate of neural activity was different in different brain regions after isoflurane inhalation was stopped.The recovery of neural activity in the primary motor cortex was delayed obviously.During the maintenance of anesthesia, the activities of most layer 2/3 cortical neurons in the retrosplenial cortex were weakened, however, some of the neurons became more active.Conclusions:The neural activity in the 2/3 layer of cortex in isoflurane anesthetized mice is inconsistent in observation region, brain region and single cell, suggesting that different neural pathways are involved in the process of anesthesia induction and recovery from anesthesia.

Objective:To establish training system for postoperative delirium (POD) assessment and evaluate the efficacy of training for anesthesia nurses.Methods:Sixteen nurse anesthetists of both sexes in our hospital were selected and received the systemic training for POD assessment.The training system included questionnaire survey, theoretical teaching, simulated visit, clinical observation, independent evaluation, centralized question-answering, evaluation of efficacy and random inspection.The level of POD knowledge tests were performed before the training and at the end of the fourth week of independent evaluation, respectively.At week 1 and 4 of independent evaluation, the diagnostic rate of POD and sensitivity and specificity of the assessment were calculated, and Kappa consistency analysis was used to assess the consistency between anesthesia nurses and training group in diagnosis of POD.In the first week of the third month after the end of training, the evaluation results were randomly inspected, the POD diagnosis rate was calculated between the anesthesia nurses and the training group, and the consistency analysis was conducted.Results:Compared with the scores of POD knowledge questionnaire and sensitivity of the assessment of the anesthesia nurses in the first week of training, the scores were significantly increased ( P<0.05), and no significant change was found in the POD diagnosis rate in the fourth week of training ( P>0.05). Compared with the training group, the diagnosis rate of POD of anesthesia nurses was significantly decreased in the first week of training ( P<0.05), and no significant change was found at the fourth week of training ( P>0.05). In the first and fourth weeks of training, the Kappa value of anesthesia nurses and the training group was 0.676 and 0.954 ( P<0.001), respectively.In the first week of the third month after the end of training, the Kappa value between anesthesia nurses and the training group in diagnosis of POD was 0.862 ( P<0.05). Conclusion:The training system of POD assessment has been successfully established, and the standardized anesthesia nurses training of POD has been achieved with good results.

Based on 18 hospitals including the Chinese People's Liberation Army General Hospital and Peking University People's Hospital, and based on the "Specifications for Perioperative Data", explore the construction and application of perioperative multi-center data centers in the era of medical big data. The use of data ferry technology avoids hidden safety hazards in hospitals, realizes the integration and sharing of perioperative medical data of various medical institutions, and forms a complete data chain combining patient medical data and follow-up data.
Hospitals, Military ; Humans ; Military Personnel ; United States

OBJECTIVE: To analyze the current status of diagnosis and management of acute appendicitis (AA) in China. METHODS: Questionnaire survey was used to retrospectively collect data of hospitalized patients with AA from 43 medical centers nationwide in 2017 (Sort by number of cases provided: Jinling Hospital of Medical School of Nanjing University, The First Affiliated Hospital of Xinjiang Medical University, Lu'an People's Hospital, Tengzhou Central People's Hospital, Dalian Central Hospital, The Affiliated Hospital of Xuzhou Medical University, Dongying People's Hospital, Jinjiang Hospital of Traditional Chinese Medicine, Huangshan Shoukang Hospital, Xuyi People's Hospital, Nanjing Jiangbei People's Hospital, Lanzhou 940th Hospital of PLA, Heze Municipal Hospital, The First College of Clinical Medical Science of China Three Gorges University, Affiliated Jiujiang Hospital of Nanchang University, The Second People's Hospital of Hefei, Affiliated Central Hospital of Shandong Zaozhuang Mining Group, The Third People's Hospital of Kunshan City, Xuzhou First People's Hospital, The 81st Group Army Hospital of PLA, Linyi Central Hospital, The General Hospital of Huainan Eastern Hospital Group, The 908th Hospital of PLA, Liyang People's Hospital, The 901th Hospital of Joint Logistic Support Force, The Third Affiliated Hospital of Chongqing Medical University, The Fourth Hospital of Jilin University, Harbin Acheng District People's Hospital, The First Affiliated Hospital of Zhengzhou University, Nanjing Luhe People's Hospital, Taixing Municipal People's Hospital, Baotou Central Hospital, The Affiliated Hospital of Nantong University, Linyi People's Hospital, The 72st Group Army Hospital of PLA, Zaozhuang Municipal Hospital, People's Hospital of Dayu County, Taixing City Hospital of Traditional Chinese Medicine, Suzhou Municipal Hospital, Beijing Guang'anmen Hospital, Langxi County Hospital of Traditional Chinese Medicine, Nanyang Central Hospital, The Affiliated People's Hospital of Inner Mongolia Medical University).The diagnosis and management of AA were analyzed through unified summary. Different centers collected and summarized their data in 2017 and sent back the questionnaires for summary. RESULTS: A total of 8 766 AA patients were enrolled from 43 medical centers, including 4 711 males (53.7%) with median age of 39 years and 958 (10.9%) patients over 65 years old. Of 8 776 patients, 5 677 cases (64.6%) received one or more imaging examinations, and the other 3 099 (35.4%) did not receive any imaging examination. A total of 1 858 (21.2%) cases received medical treatment, mainly a combination of nitroimidazoles (1 107 cases, 59.8%) doublet regimen, followed by a single-agent regimen of non-nitroimidazoles (451 cases, 24.4%), a nitroimidazole-free doublet regimen (134 cases, 7.2%), a triple regimen of combined nitroimidazoles (116 cases, 6.3%), nitroimidazole alone (39 cases, 2.1%) and nitroimidazole-free triple regimen (3 cases, 0.2%). Of the 6 908 patients (78.8%) who underwent surgery, 4 319 (62.5%) underwent laparoscopic appendectomy and 2589 (37.5%) underwent open surgery. Ratio of laparotomy was higher in those patients under 16 years old (392 cases) or over 65 years old (258 cases) [15.1%(392/2 589) and 10.0%(258/2 589), respectively, compared with 8.5%(367/4 316) and 8.0%(347/4 316) in the same age group for laparoscopic surgery, χ²=91.415, P<0.001; χ²=15.915,P<0.001]. Patients with complicated appendicitis had higher ratio of undergoing open surgery as compared to those undergoing laparoscopic surgery [26.7%(692/2 589) vs. 15.6%(672/4 316), χ²=125.726, P<0.001].The cure rates of laparoscopic and open surgery were 100.0% and 99.8%(2 585/2 589) respectively without significant difference (P=0.206). Postoperative complication rates were 4.5%(121/2 589) and 4.7%(196/4 316) respectively, and the difference was not statistically significant (χ²=0.065, P=0.799). The incidence of surgical site infection was lower (0.6% vs. 1.7%, χ²=17.315, P<0.001), and hospital stay was shorter [6(4-7) days vs. 6(5-8) days, U=4 384 348.0, P<0.001] in the laparoscopic surgery group, while hospitalization cost was higher (median 12 527 yuan vs. 9 342 yuan, U=2 586 809.0, P<0.001). CONCLUSIONS The diagnosis of acute appendicitis is still clinically based, supplemented by imaging examination. Appendectomy is still the most effective treatment at present. Laparoscopic appendectomy has become the main treatment strategy, but anti-infective drugs are also very effective.
Acute Disease ; Adolescent ; Adult ; Aged ; Anti-Bacterial Agents ; therapeutic use ; Appendectomy ; Appendicitis ; diagnosis ; therapy ; China ; Female ; Health Care Surveys ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult