Objective To explore the differences between various monitoring methods of anesthetic depth during total knee arthroplasty under general anesthesia combined with ultrasound-guided femoral nerve block.Methods From January 2021 to March 2021,60 patients undergoing total knee arthroplasty under ultrasound-guided femoral nerve block combined with general anesthesia were randomly divided into IoC group and BIS group,30 cases in each group.IoC group awareness index(Index of Consciousness,IoC)monitoring;bIS group was monitored by bispectral index(BIS)to guide the use of sedative and analgesic drugs during operation.The primary outcome measure was the time of first eye opening,and the secondary outcome measures included the average target concentration of sedative and analgesic drugs during operation,the number of perioperative adverse events and the quality of recovery.Results The average difference in the first eye opening time between the two groups was 1.57 min(95％confidence interval:-0.61～2.63).The upper limit of the 95％confidence interval was 2.63 min,which was less than the non-inferiority boundary value(δ=2.8 min),suggesting that the non-inferiority hypothesis of the main efficacy indicators was established.There was no significant difference in the dosage of propofol and sufentanil and the quality of recovery between the two groups(P＞0.05).The target-controlled concentration of remifentanil in IoC group(8.55±1.45)ng/ml was significantly higher than that in BIS group(4.62±0.96)ng/ml,and the difference was statistically significant(P＜0.05).At the same time,compared with BIS group,the number of stress hypertension(10 vs 32)in IoC group was significantly reduced and the number of bradycardia(17 vs 6)was significantly increased,the difference was statistically significant(P＜0.05).At the same time,no intraoperative awareness and body movement were found in both groups.Conclusion During total knee arthroplasty surgery under general anesthesia combined with ultrasound-guided femoral nerve block:1.IoC monitoring is not inferior to BIS monitoring in terms of awakening speed and quality.2.The increased use of remifentanil in the IoC group and the reduced incidence of hypertension may indicate that IoC monitoring is more sensitive to intraoperative nociceptive stimuli.

Objective To measure the three-dimensional(3D)motion of the knee joint in healthy people and patients after total knee arthroplasty(TKA).Methods The coordinate system for the tibia and femur of the knee joint was established,and the marking points were pasted at the bone landmarks.Then the 3D motion of human knee joint was measured by biplane high-speed photogrammetry,and the data were processed according to the coordinate transformation.Results The peak values of adduction and abduction,internal and external rotation,internal and external translation,and proximal and distal movement of the artificial knee joint were larger than those of the healthy knee joint(P<0.05),but there was no statitistic difference in posterior displacement between the artificial and healthy knee joints(P=0.05).Conclusions By measuring the knee joint motion,not only the difference in knee joint motion between the healthy volunteers and TKA patients was revealed,but also the effectiveness of biplane high-speed photography in knee joint kinematic measurement was demonstrated.

Objective To explore the differences between various monitoring methods of anesthetic depth during total knee arthroplasty under general anesthesia combined with ultrasound-guided femoral nerve block.Methods From January 2021 to March 2021,60 patients undergoing total knee arthroplasty under ultrasound-guided femoral nerve block combined with general anesthesia were randomly divided into IoC group and BIS group,30 cases in each group.IoC group awareness index(Index of Consciousness,IoC)monitoring;bIS group was monitored by bispectral index(BIS)to guide the use of sedative and analgesic drugs during operation.The primary outcome measure was the time of first eye opening,and the secondary outcome measures included the average target concentration of sedative and analgesic drugs during operation,the number of perioperative adverse events and the quality of recovery.Results The average difference in the first eye opening time between the two groups was 1.57 min(95％confidence interval:-0.61～2.63).The upper limit of the 95％confidence interval was 2.63 min,which was less than the non-inferiority boundary value(δ=2.8 min),suggesting that the non-inferiority hypothesis of the main efficacy indicators was established.There was no significant difference in the dosage of propofol and sufentanil and the quality of recovery between the two groups(P＞0.05).The target-controlled concentration of remifentanil in IoC group(8.55±1.45)ng/ml was significantly higher than that in BIS group(4.62±0.96)ng/ml,and the difference was statistically significant(P＜0.05).At the same time,compared with BIS group,the number of stress hypertension(10 vs 32)in IoC group was significantly reduced and the number of bradycardia(17 vs 6)was significantly increased,the difference was statistically significant(P＜0.05).At the same time,no intraoperative awareness and body movement were found in both groups.Conclusion During total knee arthroplasty surgery under general anesthesia combined with ultrasound-guided femoral nerve block:1.IoC monitoring is not inferior to BIS monitoring in terms of awakening speed and quality.2.The increased use of remifentanil in the IoC group and the reduced incidence of hypertension may indicate that IoC monitoring is more sensitive to intraoperative nociceptive stimuli.

Objective To measure the three-dimensional(3D)motion of the knee joint in healthy people and patients after total knee arthroplasty(TKA).Methods The coordinate system for the tibia and femur of the knee joint was established,and the marking points were pasted at the bone landmarks.Then the 3D motion of human knee joint was measured by biplane high-speed photogrammetry,and the data were processed according to the coordinate transformation.Results The peak values of adduction and abduction,internal and external rotation,internal and external translation,and proximal and distal movement of the artificial knee joint were larger than those of the healthy knee joint(P<0.05),but there was no statitistic difference in posterior displacement between the artificial and healthy knee joints(P=0.05).Conclusions By measuring the knee joint motion,not only the difference in knee joint motion between the healthy volunteers and TKA patients was revealed,but also the effectiveness of biplane high-speed photography in knee joint kinematic measurement was demonstrated.

ObjectivesTo explore the effect of diffuse glioma with precentral-gyrus invasion on fMRI activation maps by grasping T-fMRI. MethodsA total of 56 diffuse glioma patients were divided into precentral-gyrus invasion （PGI： n=21） and precentral-gyrus non-invasion （PGNI： n=35） groups. Three statistical thresholds （P value： 10^-4， P1； 10^-6， P2； 10^-8， P3） were set to obtain the activation maps accordingly （V1， V2 and V3）. The interhemispheric and bilateral precentral gyrus activation volumes ratios （IAVR and PAVR） were calculated， respectively. The activation volumes ［△V1=V1-V2； △V2=V2-V3； △Vn （ipsilateral）/△Vn’ （contralateral）， n=1， 2］ within two statistical thresholds and the corresponding interhemispheric ratio was further compared. In addition， the associations of tumor characteristics with IAVR and PAVR were analyzed. ResultsCompared with PGNI， PGI showed significantly decreased IAVR at p1， and the same trends of PAVR in PGI at P1 and P2 （P＜0.05）. However， neither IAVR nor PAVR showed significant differences at P3. PGI showed significantly lower ratios of △V1/△V1’ than PGNI （P=0.02）， except for △V2/△V2’. Additionally， within PGI， PAVR was negatively correlated with tumor volume （P=0.043）， and the distance from the tumor to the hand-knob was positively correlated with the IAVR and PAVR （P＜0.05）. ConclusionDiffuse glioma invading eloquent areas tended to affect interhemispheric asymmetry of activation at relatively lower statistical thresholds than diffuse glioma without invasion， rather than stricter statistical thresholds. Multiple ranges of statistical thresholds were recommended to analyze T-fMRI.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species (excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.

Hepatocellular carcinoma (HCC) is characterized by high postoperative recurrence and mortality rates. In recent years, researchers have identified a significant correlation between microvascular invasion (MVI) and early postoperative recurrence and metastasis of HCC, making it a focal point of HCC research. Accurate preoperative prediction of MVI occurrence and the implementation of relevant interventions (such as expanded resection) could provide substantial benefits to patients. This study analyzes global research over the past decade on MVI predictive indicators based on tumor biological characteristics, genetic measurements, imaging examinations, and tumor markers. The aim is to use these predictive indicators to objectively forecast the occurrence of MVI, thereby aiding in preoperative individual assessments and enhancing treatment plans.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species (excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.

Female ; Humans ; Hypoglycemic Agents/therapeutic use* ; Insulin Resistance ; Metformin/therapeutic use* ; Phosphatidate Phosphatase ; Pioglitazone/therapeutic use* ; Polycystic Ovary Syndrome/genetics*

Objective:To investigate the safety and efficacy of stent-assisted coil embolization in acute intracranial ruptured wide-necked aneurysms, and explore the safety of different antiplatelet drug regimens during perioperative period and the risk factors for prognoses.Methods:A perspective multicenter study was performed. A total of 417 patients with intracranial ruptured wide-necked aneurysms treated by stent-assisted coil embolization in Neurosurgery Departments of 4 hospitals (First Affiliated Hospital of Wenzhou Medical University [ n=41], Zhujiang Hospital of Southern Medical University [ n=111], Tangdu Hospital of Air Force Military Medical University [ n=100], and Xuanwu Hospital of Capital Medical University [ n=165]) from June 2017 to January 2020 were included. According to the different antiplatelet drugs regimens used in perioperative period, these patients were divided into loaded clopidogrel group ( n=87), loaded clopidogrel combined with aspirin group ( n=212), and tirofiban group ( n=118). Clinical data and perioperative complications of 3 groups were compared. Modified Rankin scale (mRS) was used to evaluate the prognoses of patients at discharge; differences of clinical data between the poor prognosis group and good prognosis group were compared. Independent risk factors for prognoses of patients with intracranial ruptured wide-necked aneurysms were analyzed by multivariate Logistic regression analysis. Receiver operating characteristic (ROC) curve was used to analyze the predictive values of risk factors in poor prognosis. Results:Degrees of aneurysm embolization immediately after surgery: Raymond grading I was noted in 351 patients (84.2%), grading II in 44 patients (10.6%), and grading III in 22 patients (5.2%). Perioperative complications were noted in 44 patients (10.6%), and death was noted in 4 (1%). Intraoperative thrombosis incidence of the loaded clopidogrel group, loaded clopidogrel combined with aspirin group and tirofiban group was 5.7% (5/87), 5.7% (12/212) and 0.8% (1/118); that in tirofiban group was significantly lower than that in the loaded clopidogrel group and loaded clopidogrel combined with aspirin group ( P<0.05). At discharge, 360 patients (86.3%) had good prognosis and 57 patients (13.7%) had poor prognosis. Multivariate Logistic regression analysis showed age≥60 years ( OR=3.407, 95% CI: 1.620-7.166, P=0.001), preoperative Hunt-Hess grading 3 ( OR=11.445, 95% CI: 3.584-36.547, P<0.001), preoperative Hunt-Hess grading 4 ( OR=88.951, 95% CI: 14.519-544.948, P<0.001), preoperative Hunt-Hess grading 5 ( OR=64.949, 95% CI: 12.809-329.325, P<0.001), and multiple stenting ( OR=4.709, 95% CI: 1.215-18.248, P=0.025) were independent risk factors for poor prognosis of these patients. ROC curves showed that area under the curve of combination of age, number of implanted stents, and preoperative Hunt-Hess grading in predicting poor prognosis of these patients was 0.821, with optimal diagnostic threshold of 0.500, sensitivity of 0.667, and specificity of 0.833. Conclusion:Stent-assisted coil embolization is safe and effective in acute intracranial ruptured wide-necked aneurysms; tirofiban is safe as perioperative antiplatelet drug; patients with old age, preoperative Hunt-Hess grading≥3, and multiple stents are prone to have poor prognosis.