To investigate the incidence of postoperative neuropsychic dysfunction (PND) in Parkinson's disease (PD) patients undergoing deep brain stimulation (DBS) and to analyze its influencing factors.

Objective To observe the effects of epidural anesthesia and subarachnoid anesthesia on puerperants and fetus perioperatively undergoing cesarean delivery after epidural labor analgesia.Methods A retrospective cohort study was conducted to select and analyze the relevant clinical data of women who had epidural labor anal-gesia and were converted to cesarean delivery at Beijing Tiantan Hospital.According to the anesthesia method of cesarean section,the participants were divided into the epidural anesthesia(EA)group and the subarachnoid an-esthesia(SA)group.That were aimed to compare the effects of the two anesthesia methods on the mother and fe-tus perioperatively.Results Compared with women in the epidural anesthesia group,women in the subarachnoid anesthesia group had a better anesthesia outcome,visual analogue scale(VAS)scores,frequency(%)[VAS scores 0-3:5(25%)vs.14(70%);VAS scores 4-6:12(60%)vs.6(30%);and VAS scores 7-10:3(15%)vs.6(30%)],and higher perioperative complication rate.There was nonsignificance difference in perio-perative maternal bleeding,neonatal Apgar score,and neonatal umbilical artery blood gas analysis between the two groups.Conclusions In women with epidural analgesia undergoing cesarean section,the anesthesia effect of subarachnoid anesthesia is better than that of the epidural anesthesia.The anesthesiologist must pay attention to prevent complications in the perioperative period.

Objective To develop and validate a prediction model for severe disability or death(SDD)in acute ischemic stroke(AIS)patients who underwent endovascular treatment(EVT).Methods Based on the dataset of ANGEL-ACT study who received EVT for AIS between november 2017 and march 2019,a retrospective analysis was performed on 1 677 patients,including 1 111 males and 566 females,aged ≥ 18 years.Patients were divided into two groups according to whether SDD occurred(mRS 5-6 scores 90 days after surgery):SDD group(n=478)and non-SDD group(n=1 199).Risk factors that might influence SDD after EVT in AIS patients were screened and analyzed by multifactorial analysis,LAS-SO regression,and RF-RFE methods.A nomogram was developed after evaluating the model performance and the execution of internal validation.Results SDD occurred in 380(28.1％)patients in the develop-ment cohort and 98(30.2％)patients in the validation cohort.Combining the three variable screening meth-ods,10 risk factors were selected for inclusion in the final model:age,NIHSS score,whether successful re-canalization,glucose level,hemoglobin,hematocrit,onset to puncture time,systolic blood pressure,AS-PECT score,and whether have treatment-related serious adverse events.A two-stage model means that model 1 contains pre-treatment variables(7 in total)and model 2 contains pre-treatment and post-treatment variables(10 in total).The area under the curve(AUC)of model 1 in the development cohort was 0.705(95％CI 0.674-0.736)and 0.731(95％CI 0.701-0.760)in model 2.Both models had good calibration with aslope of 1.000,and the decision curve analysis showed good clinical applicability.The results of the validation cohort were similar to those of the development cohort.Conclusion Age,admission NIHSS score,whether successful recanalization,admission glucose level,hemoglobin content,erythrocyte pressure volume,onset to puncture time,admission systolic blood pressure,ASPECT score,and whether have treat-ment-related serious adverse events are risk factors for SDD in patients with acute ischemic stroke.The two prediction models based on the above factors were used before and after endovascular treatment to predict SDD occurrence better.

Objective:To identify the risk factors for chronic postsurgical pain (CPSP) after craniotomy.Methods:This was a single-center retrospective cohort study.The patients who underwent craniotomy in Beijing Tiantan Hospital, Capital Medical University from December 2019 to May 2020 were enrolled.The occurrence of CPSP, anxiety, depression and quality of life were determined by telephone follow-up with Short-form McGill Pain Questionnaire-2, Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-Item, a five-level EuroQol five-dimensional questionnaire.The patients were divided into CPSP group ( n=106) and non-CPSP group ( n=252) according to the results of investigation.Then univariate analysis and logistic regression analysis were performed to identify the risk factors for CPSP. Results:There was significant difference in age, a history of preoperative pain, a history of alcohol addiction, transoccipital approach and degree of lesion resection between the two groups ( P<0.05). The results of logistic regression analysis showed that age ≥ 60 yr was a protective factor for CPSP after craniotomy; a history of preoperative pain ≥3 months, a history of alcohol addiction, transoccipital approach and partial resection of the lesion were independent risk factors for CPSP after craniotomy. Conclusion:Age≥60 yr is a protective factor for CPSP after craniotomy; a history of preoperative pain (≥3 months), a history of alcohol addiction, transoccipital approach and partial resection of the lesion are independent risk factors for CPSP after craniotomy.

Objective To investigate the effect of different concentrations of morphine on the viability of cortical neurons and synaptic plasticity in newborn mice.Methods Cortical neurons isolated from male C57/BL/6 mice within 24 h after birth were seeded in 60-mm cultured dish (10 ml),24-well plates (500 ml) and 96-well plates (100 ml) at a density of 2×106,1×105 and 1.5×104 cells per plate/well,respectively,and cultured for 7 days.Neurons were then divided into 4 groups (n =6 each) using a random number table method:control group (group C),morphine 1.0 mmol/L group (group M1),morphine 10.0 mmol/L group (group M2),and morphine 100.0 mmol/L group (group M3).Neurons were incubated for 48 h with morphine 1.0,10.0 and 100.0 mmol/L in M1,M2 and M3 groups,respectively.MTT assay was used to measure the cell viability,immunofluorescence to measure the length of microtube-associated protein-2-labeled dendrites,and Western blot to detect the expression of caveolin-1 (Cav-1),growth-associated protein-43 (GAP-43),synapsin,synaptophysin Ⅰ and vesicle-associated membrane protein.Results Compared with group C,the length of dendrites was significantly prolonged,and the expression of Cav-1,GAP-43,synapsin,synaptophysin Ⅰ and vesicle-associated membrane protein was up-regulated in group M2,and the cell viability was significantly decreased,and the expression of Cav-1,GAP-43 and vesicle-associated membrane protein was up-regulated in group M3 (P＜ 0.05).Conclusion Morphine 10.0 mmol/L causes no damage to cortical neurons and enhances synaptic plasticity of neurons in newborn mice.

Following the blood pressure, pulse, breathing and body temperature, pain was identified as the fifth vital signs.Postoperative pain of the spine and spinal cord surgery was a neuropathic pain, it was severe and may affect multiple systems of the patients.Therefore, postoperative analgesia of spine and spinal cord surgery is very important.

Objective To evaluate the effects of different positions on cerebral blood flow in patients undergoing laparoscopic surgery.Methods Thirty patients of both sexes,aged 23-64 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective laparoscopic surgery,were included.Patients' position was changed using a random number table after induction of anesthesia.Patients were placed in the supine position and tilted 15° head-up or 15° head-down,and the parameters of the middle cerebral artery were monitored using the transcranial Doppler ultrasound.After admission to the operating room (baseline),after induction of anesthesia and before pneumoperitoneum,in the supine position,at head-up tilt and at head-down tilt,the mean blood flow velocity,pulsatility index,resistance index,mean arterial blood pressure (MAP) and heart rate were recorded.Results Compared with the baseline in the supine position,the MAP and bilateral mean blood flow velocity were significantly decreased at head-up tilt,and the MAP and bilateral pulsatility and resistance indices were significantly increased at head-down tilt (P＜0.05).Conclusion During laparoscopic surgery,head-up tilt can lead to a decrease in cerebral blood flow,and head-down tilt exerts no effect on cerebral blood flow.

Objective To explore the predictors of perioperative ischemic stroke following percutaneous transluminal angioplasty and stenting.Methods We retrospectively evaluated data on 416 percutaneous transluminal angioplasty and stenting (PTAS) procedures at (334 males,82 females,aged 40-85 years,falling into ASA Ⅰ-Ⅲ) a single institution.Logistic regression was used to analyze the role of clinical,angiographic and hemodynamic variables on periprocedural ischemic strokes.Results Among 328 patients underwent PTAS for the treatment of extracranial stenosis,10 patients (3.0％) had perioperative ischemic stroke.Among the 88 stenting for intracranial stenosis,6 patients (6.8 ％) had perioperative ischemic stroke.Multivariable predictors of perioperative ischemic stroke for stenting for extracranial stenosis were the presence of untreated intracranial artery stenosis (OR =9.44,95％CI 2.36-37.71,P=0.001) and intraoperative absolute minimal SBP＜90 mm Hg (OR=9.13,95％CI 1.35-61.76,P =0.023).The independent predictors of perioperative ischemic stroke following PTAS for intracranial stenosis included the patients' increasing age (OR =1.25,95 ％ CI 1.04-1.51,P=0.021),presence of calcific plaques (OR=11.02,95％CI 1.11-109.25,P=0.040) and untreated intracranial artery stenosis (OR =44.81,95％ CI 1.99-1 011.84,P =0.017).Conclusion For patients with extracranial stenosis,suffering from the presence of untreated intracranial artery stenosis and intraoperative absolute minimal SBP＜90 mm Hg are the independent risk factors for perioperative ischemic stroke.The patients' increasing age,presence of calcific plaques and untreated intracranial artery stenosis were the independent risk factors for this complication in patients with intracranial stenosis.

Objective To evaluate protective ventilation(PV) versus conventional ventilation(CV) for surgery in the prone position.Methods We searched PubMed, Embase, the Cochrane Library, WanFang Data and other Chinese databases to collect the randomized controlled trails (RCTs) on intraoperative PV in comparison with CV for surgery in the prone position.Two authors independently identified the studies, performed data extraction and assessed the risks of bias in the included studies according to the Cochrane Handbook for Systematic Reviews of Interventions.The reviewers conducted data analyses with RevMan software.Results A total of 9 RCTs involving 449 participants were included.The results showed that the incidence of postoperative pulmonary complications (RR 0.30, 95% CI 0.12~0.73, P<0.01) and peak pressure (MD-3.52, 95% CI-6.93~-0.11, P<0.05) were lower in the PV group.Intraoperative PaO2/FiO2 was higher (MD 37.28, 95% CI 22.67~51.89, P<0.001) and alveolar-arterial oxygen difference was lower (MD-45.50, 95% CI-61.35~-29.65, P<0.001) in the PV group.Conclusions Low tidal volume ventilation in combination with positive end-expiratory pressure (with or without recruitment maneuver) decreases postoperative pulmonary complications,reduces peak pressure and improves oxygenation for surgery in the prone position.

Objective To evaluate the agreement of bispectral index values recorded from tumor side and the contralateral areas during supratentorial craniotomy.Methods Thirty-five patients (16 males, 19 females, aged 18-65 years, ASA physical status Ⅱ or Ⅲ) scheduled for supratentorial tumor resection were enrolled in this study.Bispectral index (BIS) sensors were placed at bilateral frontal areas.The patients were anesthetized with propofol.From each BIS monitor, we collected data at each of four time stages: before the induction of anesthesia, before dura opening, removal of tumor and recovery of conscious.These data were compared using Bland-Altman analysis.Results Bland and Altman analysis revealed a BIS negative-bias (limits of agreement) of before induction-0.8(-7.2-5.7), before dura opening 0.6 (-8.3-9.5), and removal of tumor 1.5(-6.9-9.9), recovery of conscious 0.2 (-9.3-9.8).Conclusion There are significant agreement for BIS values between the frontal area of tumor side and the contralateral areas.BIS values can be used interchangeably between bilateral frontal.