Objective:To explore the learning patterns of resident physicians in anesthesiology when performing tracheal intubation guided by Shikani laryngoscope, and provide a reference for the skill training of clinical anesthesiologists.Methods:From August 2023 to December 2024, a total of 19 resident physicians specializing in anesthesiology participated in this study at Peking University Third Hospital. All resident physicians received standardized training on clinical skills. None of them had received specialized training in Shikani laryngoscope-guided tracheal intubation. The relevant theoretical teaching and practical guidance were provided by the same senior attending physician throughout the study. A flipped-classroom teaching model was adopted, and each student was instructed by the teaching physician to perform the procedure on 15 cases in chronological order, resulting in a total of 285 cases. The cumulative sum (CUSUM) value for each tracheal intubation was calculated, and the learning curve was plotted using R software. A fourth-order polynomial nonlinear regression model was used to fit the curve and estimate the 95% confidence interval of the learning curve. The first-order derivative function of the regression model was further analyzed to reveal the dynamic changes in proficiency with the number of training sessions. The CUSUM curve was segmented using the maximum statistics test to identify the optimal breakpoint.Results:The maximum selection test revealed that the breakpoint for the increase in CUSUM level was at the eighth attempt.Conclusions:Resident physicians in anesthesiology can master Shikani laryngoscope-guided tracheal intubation after eight standardized training sessions. Moreover, the participants showed high satisfaction with the flipped-classroom teaching model.

Objective:To explore the learning patterns of resident physicians in anesthesiology when performing tracheal intubation guided by Shikani laryngoscope, and provide a reference for the skill training of clinical anesthesiologists.Methods:From August 2023 to December 2024, a total of 19 resident physicians specializing in anesthesiology participated in this study at Peking University Third Hospital. All resident physicians received standardized training on clinical skills. None of them had received specialized training in Shikani laryngoscope-guided tracheal intubation. The relevant theoretical teaching and practical guidance were provided by the same senior attending physician throughout the study. A flipped-classroom teaching model was adopted, and each student was instructed by the teaching physician to perform the procedure on 15 cases in chronological order, resulting in a total of 285 cases. The cumulative sum (CUSUM) value for each tracheal intubation was calculated, and the learning curve was plotted using R software. A fourth-order polynomial nonlinear regression model was used to fit the curve and estimate the 95% confidence interval of the learning curve. The first-order derivative function of the regression model was further analyzed to reveal the dynamic changes in proficiency with the number of training sessions. The CUSUM curve was segmented using the maximum statistics test to identify the optimal breakpoint.Results:The maximum selection test revealed that the breakpoint for the increase in CUSUM level was at the eighth attempt.Conclusions:Resident physicians in anesthesiology can master Shikani laryngoscope-guided tracheal intubation after eight standardized training sessions. Moreover, the participants showed high satisfaction with the flipped-classroom teaching model.

Objective:To identify the influencing factors of postoperative nausea and vomiting (PONV) in the patients undergoing egg retrieval with general anesthesia for in vitro fertilization-embryo transfer (IVF-ET).Methods:This was a case-control study. Medical records from IVF-ET patients undergoing egg retrieval with general anesthesia in the Center for Reproductive Medicine in our hospital from November to December 2020 were retrospectively collected, 52 patients with PONV were identified (group PONV), and 252 patients without PONV were selected as control group (group C). Univariate analysis was performed on the suspicious influencing factors, and the factors with statistically significant differences were included in the logistic regression analysis model to identify the influencing factors of PONV.Results:Compared with group C, statistically significant differences were found in the number of eggs, anesthesia time, and the proportion of PONV history and/or motion sickness history in group PONV ( P<0.05). The results of multivariate logistic regression analysis showed that a large number of eggs, long anesthesia time, and a high proportion of PONV history and/or motion sickness history were independent risk factors for PONV. Conclusions:A large number of eggs, long anesthesia time, and a high proportion of PONV history and/or motion sickness history are independent risk factors for PONV in IVF-ET patients undergoing egg retrieval with general anesthesia.

With the deepening of the research on uric acid, it has been found that abnormal uric acid metabolism is not only related to kidney and cardiovascular diseases, but also closely related to reproductive system diseases such as polycystic ovary syndrome (PCOS). Uric acid can play an important role in the occurrence and development of PCOS through oxidative stress, chronic inflammation and interference with key enzyme activities. PCOS is primarily characterized by hyperandrogenemia, insulin resistance, and dysregulation of glucose and lipid metabolism. Researches have found that there is an interaction between hyperuricemia and hyperandrogenemia, as well as abnormal glucose and lipid metabolism. Additionally, elevated serum uric acid levels are associated with a higher incidence of pregnancy complications and adverse pregnancy outcomes in women with PCOS. However, there are few reviews on this aspect. Therefore, this review aims to provide a more comprehensive scientific basis for the clinical treatment and management of PCOS by deeply exploring the relationship between uric acid metabolism and the main clinical manifestations of PCOS, as well as the impact of abnormal uric acid metabolism on pregnancy outcomes and complications in PCOS patients.

With the deepening of the research on uric acid, it has been found that abnormal uric acid metabolism is not only related to kidney and cardiovascular diseases, but also closely related to reproductive system diseases such as polycystic ovary syndrome (PCOS). Uric acid can play an important role in the occurrence and development of PCOS through oxidative stress, chronic inflammation and interference with key enzyme activities. PCOS is primarily characterized by hyperandrogenemia, insulin resistance, and dysregulation of glucose and lipid metabolism. Researches have found that there is an interaction between hyperuricemia and hyperandrogenemia, as well as abnormal glucose and lipid metabolism. Additionally, elevated serum uric acid levels are associated with a higher incidence of pregnancy complications and adverse pregnancy outcomes in women with PCOS. However, there are few reviews on this aspect. Therefore, this review aims to provide a more comprehensive scientific basis for the clinical treatment and management of PCOS by deeply exploring the relationship between uric acid metabolism and the main clinical manifestations of PCOS, as well as the impact of abnormal uric acid metabolism on pregnancy outcomes and complications in PCOS patients.

Objective:To investigate the incidence and potential risk factors associated with postopera-tive spinal epidural hematoma(SEH)following anterior cervical spine surgery(ACSS).Methods:A retrospective analysis was conducted on the clinical data of patients who underwent ACSS for cervical spondylosis at Peking University Third Hospital between March 2013 and February 2022.Patients who developed postoperative SEH were categorized as the SEH group,while those in the cohort without SEH were randomly selected as the non-SEH group by individually matching with the same operator,same gender,same surgery year,and similar age(±5 years)at a ratio of 4:1.The general condition,pre-operative comorbidities,anticoagulant or antiplatelet therapy,preoperative coagulation and platelet counts,American society of Anesthesiologists physical status classification,cervical spondylosis classifi-cation,preoperative modified Japanese Orthopaedic Society score and cervical disability index score,sur-gical modality,surgical segment levels,ossification of the posterior longitudinal ligament among the surgi-cal level,surgery duration,estimated blood loss,postoperative drainage volume,preoperative mean arte-rial pressure,mean arterial pressure during postoperative awakening periods,hospital stay and hospitali-zation cost were compared between the two groups.A bivariate Logistic regression model was applied to screen out the independent risk factors and calculate the odds ratios of indicators associated with SEH.Receiver operating characteristic curve and area under the curve(AUC)were used to describe the dis-crimination ability of the indicators.Results:A total of 85 patients were enrolled in the study,including 17 patients in the SEH group and 68 patients in the non-SEH group.Seventeen patients with SEH under-went hematoma evacuation,and all of them were successfully treated and discharged from the hospital.Corpectomy(OR=7.247;95％CI:1.962-26.766;P=0.003)and the highest mean arterial pressure during awakening(OR=1.056;95％CI:1.002-1.113;P=0.043)were independent risk factors for SEH.The AUC values were 0.713(95％CI:0.578-0.848)and 0.665(95％CI:0.51-0.82)re-spectively.The patients with SEH had longer hospital stays(P＜0.001)and greater hospitalization costs(P=0.035).Conclusion:Corpectomy and elevated maximum mean arterial pressure during awakening are independent risk factors for the development of postoperative SEH following ACSS.High-risk patients should be closely monitored during the perioperative period.

Objective:To observe the distribution of 177Lu-FA-DOTA-PEG-PLGA nanoparticles in vivo, and evaluate the therapeutic effect of nanoparticles intraperitoneal injection on ovarian cancer peritoneal metastases and ascites. Methods:Nanoparticles were prepared and injected into human ovarian cancer xenograft nude mice model by tail vein. Micro-SPECT/CT imaging was performed at different times (4, 24, 72 h and 7 d) after injection to observe the distribution of nanoparticles in vivo. Nude mouse models of intraperitoneal metastases of human ovarian cancer were randomly divided into negative control group (normal saline), chemotherapy group (cisplatin 3 mg/kg, twice a week) and nanoparticle group (18.5 MBq), with 4 mice in each group. After 7 days, intraperitoneal tumor growth was evaluated by in vivo fluorescence imaging. The relative tumor inhibition rate was counted. Tumor cell apoptosis rate was detected by TUNEL method, and the proliferation activity tumor Ki67 was detected by immunohistochemical method. The ascites volume of each group was compared after treatment. Results:Micro-SPECT/CT imaging showed the radioactive uptake of the transplanted tumor, and the 24 h tumor muscle uptake ratio (T/M) was the highest, about 2.81±0.49. Intravital fluorescence imaging showed that, after intraperitoneal administration, the fluorescence intensity of abdominal tumor in particle group, chemotherapy group and control group was (1.45±0.19)×10 10, (2.21±0.36)×10 10 and (2.63±0.79)×10 10( F=6.09, P=0.029), respectively. The relative tumor growth inhibition (TGI) of the particle group and the chemotherapy group were 35.6% and 18.6%, respectively. The tumor cell apoptosis rates in particle group and chemotherapy group were higher than those in control group ( F=9.96, P=0.009). Ki67 indexes in particle group and chemotherapy group were lower than those in control group ( F=9.93, P=0.013). The ascites volume in particle group and chemotherapy group were both smaller than those in control group ( F=13.43, P=0.006). Conclusions:177Lu-FA-DOTA-PEG-PLGA nanoparticles can be used for the targeted imaging of ovarian cancer. After intraperitoneal injection, nanoparticles show local retention, degradation and absorption and thus inhibit the growth of peritoneal metastases and ascites of ovarian cancer, which provides a new idea for the diagnosis and treatment of advanced ovarian cancer with peritoneal metastasis.

Objective:To explore the relationship between different gestational weeks of transvaginal ultrasound-guided fetal reduction and abortion in patients with multiple pregnancies after embryo transfer, and to seek the best gestational age for fetal reduction.Methods:The datas of 486 pregnant women with multiple pregnancies after embryo transfer in the Second Hospital of Hebei Medical University from January 2012 to December 2020 were retrospectively analyzed. The relationship between gestational weeks of fetal reduction and abortion rate was analyzed by curve fitting, threshold effect and multivariate logistic regression analysis.Results:After adjusting for age, infertility type, infertility years, number of births, abortion times, body mass index(BMI), various infertility and sterility factors, endometrial thickness on the day of transformation, monozygotic twins and reduction methods, when the gestational age was less than 8.43 weeks, the abortion rate increased significantly with the increase of reduction gestational age, and the abortion rate increased by 221% ( OR=3.21, 95% CI=1.47-6.99, P=0.003 3). When the gestational age of reduction ≥8.43 weeks, the abortion rate tended to be stable and did not increase ( OR=0.81, 95% CI=0.54-1.22, P=0.317 7); meanwhile, in stratified analysis, the OR value of the BMI ≥24 kg/m 2 was 12.38, and that of BMI <24kg/m 2 was 1.91, P=0.053 9. Conclusions:There is a non-linear relationship between gestational age and abortion rate of ultrasound-guided multiple pregnancy reduction in patients with embryo transfer. The abortion rate increases significantly with the increase of gestational age before 8.43 weeks of gestation. It is recommended to carry out the operation as early as possible before 8 weeks of pregnancy. The effect of BMI on the abortion rate of patients with fetal reduction needs further study.

Objective: To analyze the maternal and fetal outcomes of pregnancies complicated by aplastic anemia (AA) and to investigate the underlying risk factors. Methods: In this retrospective case control study, we retrieved medical records of 85 singleton gravidas with AA (AA group) who were admitted to Peking University People's Hospital from January 2003 to January 2016, and another 340 singleton gravidas (case∶control=1∶4) without blood system or immune system diseases who gave birth at the same period were selected as the control group. Differences in general condition and the incidence of maternal and neonatal complications were compared between the two groups. AA group were further divided into adverse outcome subgroup (n=33) and non-adverse outcome subgroup (n=52), and relevant factors were also analyzed. Statistical analysis was performed using t-test, Chi-square test and logistic regression. Results: No maternal deaths occurred in all 85 cases of AA group, 81 of them gave live birth [one neonate died and the others survived with a mean gestational age of 36⁺⁵ weeks (30⁺²-40⁺⁵ weeks)], and 45 developed maternal or fetal adverse outcomes. Compared with the control group, AA group had higher incidences of hypertensive disorders of pregnancy [20.0% (17/85) vs 6.2% (21/340)], acute heart failure [7.1% (6/85) vs 0.0% (0/340)], postpartum hemorrhage [5.9% (5/85) vs 0.9% (3/340)], puerperal infection [2.4% (2/85) vs 0.0% (0/340)], preterm birth [22.3% (19/85) vs 5.6% (19/340)], small for gestational age [11.7% (10/85) vs 0.9% (3/340)], fetal growth restriction [8.2% (7/85) vs 1.2% (4/340)], intrauterine fetal death [4.7% (4/85) vs 0.0% (0/340)] and neonatal death [1.2% (1/85) vs 0.0% (0/340)] (all P<0.05). After adjusting for age, pregnancy history and the time of diagnosis, we found that low median (OR=0.88, 95%CI: 0.83-0.95), mean (OR=0.85, 95%CI: 0.79-0.93) and minimal (OR=0.87, 95%CI: 0.82-0.93) values of hemoglobin concentration during pregnancy, and low median (OR=0.96, 95%CI: 0.92-1.00), mean (OR=0.96, 95%CI: 0.92-1.00) and minimal (OR=0.95, 95%CI: 0.90-0.99) values of platelet counts during pregnancy were risk factors for adverse maternal and fetal outcomes of gravidas with AA (all P<0.05). Conclusions Maternal and fetal complications are more common in pregnant women with AA and maintain hemoglobin and platelet counts at a certain level may improve the outcomes.