Objective:To establish a predictive model for post-induction hypotension (PIH) in the patients undergoing colorectal cancer resection using machine learning algorithms based on muscle CT parameters.Methods:This was a single-center, retrospective study. Electronic medical records from 318 patients who underwent colorectal cancer resection from September 1, 2018 to September 30, 2021 at our hospital were collected. Predictive variables included age, gender, body mass index, hemoglobin, American Society of Anesthesiologists Physical Status classification, TNM staging, age-adjusted Charlson comorbidity index, prognostic nutritional index, L 3 level skeletal muscle index, and muscle quality assessed by Hounsfield unit average calculation. The outcome variable was PIH. The training and testing sets were divided based on the timeline (patients before September 1, 2020 were included in the training set, and those after that date were included in the testing set). The filtering method was used to screen the feature variables. Eight models, including logistic regression, Bayesian models, K-nearest neighbors, support vector machines, neural networks, decision trees, extreme gradient boosting trees, and random forests, were established in the training set using over-sampling technique, repeated cross-validation and hyperparameter optimization. After selecting the best model, a sorting chart of the feature variables, a univariate partial dependency profile, and a breakdown profile were drawn. In the testing set, the confusion matrix and parameters were calculated, and the receiver operating characteristic curve, precision recall curve, calibration curve, and decision curve were drawn to evaluate the performance of the predictive model. Results:The screened feature variables were Hounsfield unit average calculation value, age, L 3 level skeletal muscle index, prognostic nutritional index, hemoglobin and body mass index. The random forest was the optimal model, with an accuracy of 0.985 9, a MCC of 0.970 8, the area under the receiver operating characteristic curve was 1.0, and the area under the precision recall curve was 1.0. The Brier score of the calibration curve was 0.076 6; the decision curve showed the highest clinical net benefit of 0.6. Conclusions:In this study, machine learning algorithm is used to identify the important characteristic variables and establish a high-performance PIH prediction model based on muscle CT parameters.

Objective To explore the effect of ultra-low dose dexmedetomidine on cough during an-esthesia recovery period in elderly patients undergoing carotid artery stenting(CAS).Methods A total of 111 elderly patients,75 males and 36 females,aged≥65 years,BMI 18-32 kg/m2,ASA physical statusⅡ or Ⅲ,diagnosed with asymptomatic unilateral severe carotid artery stenosis and scheduled for CAS,were randomly assigned to two groups using a random number table:the dexmedetomidine group(group D,n = 55)and the control group(group C,n = 56).Group D was given dexmedetomidine 0.2-0.5 μg/kg before anesthesia induction,and dexmedetomidine was intravenously infused at a ultra-low dose(0.1-0.2 μg·kg-1·h-1)after anesthesia induction to 30 minutes before the end of the operation,while group C did not receive any dexmedetomidine.The anesthesia regimen and intraoperative medication were the same for both groups.The MAP and HR were recorded 15 minutes before anesthesia induction(T0),5 minutes after anesthesia induction(T1),5 minutes before stent implantation(T2),5 minutes after stent implantation(T3),and 5 minutes after tracheal extubation(T4).The dosage of intraoperative propofol and remifentanil,cough and agitation during anesthesia recovery period,respiratory depression(SpO2＜90%),extubation time,postoperative puncture infection,VAS pain score 24 hours after surgery,and postoperative nausea and vomiting were recorded.Results Compared with group C,MAP was significantly decreased at T1 and T2,increased at T3 and T4,and HR was significantly decreased at T1,T3,and T4 in group D(P＜0.05).Compared with group C,the intraoperative use of propofol and remifentanil was significantly decreased,and the incidence of cough and agitation during anesthesia recovery period was significantly decreased in group D(P＜0.05).There was no statistically significant difference in the incidence of respiratory depression,ex-tubation time,VAS pain score 24 hours after surgery,and postoperative nausea and vomiting between the two groups.None of the recruited patients experienced infection at the puncture site.Conclusion Ultra-low dose dexmedetomidine can effectively maintain intraoperative hemodynamic stability,reduce the incidence of cough and agitation during anesthesia recovery period,and does not increase other postoperative adverse re-actions,enhancing anesthesia recovery quality in elderly patients undergoing CAS.

Objective To investigate the effects of continuous infusion of extremely low-dose dexmedetomidine on the hemodynamic sta-bility and recovery of postoperative cognition of older adult patients undergoing carotid artery stenting(CAS).Methods 106 older adult patients undergoing CAS were randomly divided into the dexmedetomidine(group D,n= 52)and control groups(group C,n= 54).Hemo-dynamic and cerebral perfusion changes were recorded 15 min before anesthesia induction(T0),5 min after anesthesia induction(T1),5 min before stent placement(T2),5 min after stent placement(T3),and 5 min after tracheal extubation(T4).The standard deviations(SD)of mean arterial pressure(MAP),heart rate(HR),and regional cerebral oxygen saturation(rSO2)were calculated as SDMAP,SDHR,and SDrSO2,respectively.The Montreal Cognitive Assessment Scale(MoCA)was used to evaluate and compare changes in pre-and post-operative cognitive function and examine the incidence of postoperative cognitive dysfunction(POCD)in the two groups.Results SDMAP,SDHR,and SDrSO2 in group D were significantly lower than those in group C(P＜0.05).The applied dosages of anesthetics and vasoactive drugs were significantly lower in group D than C(P＜0.05).Extubation time in group D was significantly shorter than that in group C(P＜0.05).MoCA scores in group D were significantly higher one day after CAS than that in group C and POCD incidence was significantly lower in group D one month after CAS(P＜0.05).Conclusion Continuous infusion of low-dose dexmedetomidine has the potential to maintain hemodynamic stability and cerebral perfusion,reduce the dosage of anesthetic drugs,and improve postoperative cognitive performance in older adult patients.

Objective:To investigate the implementation status of appropriate technique of Traditional Chinese Medicine (TCM) in the perioperative period in China using questionnaires.Methods:From May to June 2022, the questionnaire designed by ourselves was sent to anesthesiologists participating in the survey through the WeChat platform nationwide, and the system automatically recorded the survey.Results:A total of 6 230 anesthesiologists participated in the questionnaire survey, there were 6 160 valid questionnaires, with an effective rate of 98.88%.The anesthesiologists participating in the questionnaire survey were distributed in 16 provincial administrative regions in China, of which the rate from tertiary hospitals was 32.59%, the rate from secondary hospitals was 67.41%, and the application rate of TCM appropriate techniques in the perioperative period was 9.8%.The application rate of TCM appropriate techniques in the perioperative period was higher in tertiary hospitals than in secondary hospitals (9.51% vs. 6.31%, P<0.05), and the application rate was significantly higher in TCM hospitals than in integrated Chinese and Western Medicine hospitals and Western medicine general hospitals (26.15% vs.7.26% vs. 2.49%, P<0.05). Among the provinces participating in the survey, Guangdong Province had the highest application rate of TCM appropriate techniques in the perioperative period (13.60%). In the anesthesiologists carried out TCM appropriate techniques in the perioperative period, the highest application rate of TCM appropriate techniques in non-drug therapy was 59.0%, and the highest application rate in abdominal surgery was 47.4%, and most anesthesiologists (68.1%) selected TCM appropriate techniques according to the type of surgery in patients.Anesthesiologists who applied TCM appropriate techniques in the perioperative period believed that TCM appropriate technique cloud reduce the development of nausea and vomiting in the perioperative period (66.8%), alleviate perioperative pain (54.8%), promote the recovery of perioperative gastrointestinal function (49.8%), and reduce the development of perioperative neurocognitive disorders (47.0%). The main reasons for the lack of TCM appropriate techniques in the perioperative period were the lack of standardized technical training and relevant guidelines (87.11%), the lack of relevant charging items (58.30%), the technical level of operators (46.20%), the lack of support by surgeons (43.40%), and the non-cooperation of patients (27.10%). Conclusions:At present, the application rate of TCM appropriate techniques in the perioperative period is generally low, and the application rate varies greatly among different provinces and hospitals of different levels.Publicity should be expanded through multiple channels, various forms of technical training should be carried out, the implementation plan and guidelines of TCM appropriate technologies should be continuously optimized, and the promotion and application of TCM appropriate techniques in the perioperative period should be strengthened.

The medical records of patients of both sexes with sleep disorders treated with multimodal sleep therapy for which patient controlled sleep with dexmedetomidine was the main method, aged≥18 yr, with body mass index of 18-30 kg/m 2, from February 2019 to January 2021, were collected.Dexmedetomidine 60 ml/h (4 μg/ml) was intravenously infused until non-rapid eye movement (NREM) Ⅲ phase was reached or the consumption of dexmedetomidine reached 1 μg/kg.Whether dexmedetomidine induced restless legs syndrome (RLS) was judged according to the Chinese guidelines for the diagnosis and treatment of restless legs syndrome (2021 edition). When the titration was stopped and on the next day after emergence from anesthesia, clinical diagnosis was performed according to Chinese guidelines for the diagnosis and treatment of restless legs syndrome (2021 edition) to determine whether RLS was combined or not.Kappa consistency analysis was used to assess the consistency between dexmedetomidine titration and the Chinese guidelines for the diagnosis and treatment of restless legs syndrome (2021 Edition) in diagnosis of RLS.The sensitivity and specificity of diagnosis of RLS by dexmedetomidine titration were calculated.A total of 39 patients were included and 8 patients had RLS symptoms which were judged accroding to dexmedetomidine titration.The results of Kappa consistency test showed that there was a strong consistency between dexmedetomidine titration and Chinese guidelines for the diagnosis and treatment of restless legs syndrome (2021 edition) (Kappa value 1.0, P<0.01). The sensitivity and specificity of dexmedetomidine titration in judging RLS were 100%.In conclusion, dexmedetomidine titration can accurately judge RLS.

Dexamethasidine (DEX) is an alpha-2 adrenoreceptor (α 2-AR) agonist, which is not only used in the perioperative period, but also in outpatient examination or treatment. The characteristics and advantages of sedation and hypnosis with DEX are that patients can enter a state similar to natural sleep, which is not only beneficial to improve the sedation effect, but also easy to wake up, and there is little jaw relaxation and no obvious respiratory inhibition. The additional advantages of DEX lie in its function of anti-stress response and potential organ protection and its little influence on cognitive function. The main adverse reactions of DEX were temporary hypertension, hypotension, bradycardia, and so on. Another characteristic of DEX is the relatively slow disappearance of drug effect. Patients may have drowsiness and postural hypotension after operation. It must be noted that DEX cannot be used as an independent anesthetic in general anesthesia to act as the main analgesic and sedative, but only to play an auxiliary role, which depends on the reasonable use and dosage and is not "all" or "none". And the vital signs of patients must be closely monitored during the process of DEX application.

Dexamethasidine (DEX) is an alpha-2 adrenoreceptor (α 2-AR) agonist, which is not only used in the perioperative period, but also in outpatient examination or treatment. The characteristics and advantages of sedation and hypnosis with DEX are that patients can enter a state similar to natural sleep, which is not only beneficial to improve the sedation effect, but also easy to wake up, and there is little jaw relaxation and no obvious respiratory inhibition. The additional advantages of DEX lie in its function of anti-stress response and potential organ protection and its little influence on cognitive function. The main adverse reactions of DEX were temporary hypertension, hypotension, bradycardia, and so on. Another characteristic of DEX is the relatively slow disappearance of drug effect. Patients may have drowsiness and postural hypotension after operation. It must be noted that DEX cannot be used as an independent anesthetic in general anesthesia to act as the main analgesic and sedative, but only to play an auxiliary role, which depends on the reasonable use and dosage and is not "all" or "none". And the vital signs of patients must be closely monitored during the process of DEX application.

The recommendations of Guideline for Emergency Management of Anaphylaxis answered 15 clinical questions about diagnosis,preparation for treatment,treatment measures,and post-treatment management of anaphylaxis and a total of 26 recommendations were formed.In the recommendations,the quality of evidence was divided into 4 levels:high,moderate,low,and very low.And the strength of recommendation was divided into 2 levels:strong and weak.The strength of recommendations was mainly determined by weighing the advantages and disadvantages,instead of relying on the quality of evidence.Emergency management of anaphylaxis in clinical practice could be carried out with reference to the recommendations of this guideline.

Objective To understand the current situation of health education contents as well as the differences in their requirements between clinical medical students and clinicians,and to provide reference for the optimization of health education curricula for medical students.Methods A stratified sampling method was adopted to select 511 medical students (303 females and 208 males) from a medical university,and the survey results of 436 clinicians (144 females and 292 males) were taken as reference.Differences in the degrees of need between clinical medical students and clinicians were compared by chi-square tests.Results There were statistical differences in needs between clinical medical students and clinicians regarding drug compliance,smoking cessation intervention,balanced diet,application of Chinese traditional rehabilitation medicine,mobile health technology education,exercise rehabilitation guidance,and theory of health promotion (P＜0.01).With regard to drug compliance,smoking cessation intervention,and exercise rehabilitation guidance,the proportions of clinical medical students' needs were just 87.1％,82.2％,and 81.2％,respectively,but for clinicians the proportions reached up to 96.3％,93.8％,and 92.8％,respectively.Whereas,there were no statistical differences for mental stress management,chronic infectious disease health education,and acute infectious disease health education (P＞0.05).Conclusion There is still a big gap between medical students and clinical doctors when it comes to the knowledge of chronic disease management and healthy lifestyles;clinical medical students have not yet realized the importance of such knowledge and skills.Therefore,the strengthening of course construction for clinical medical students is suggested.

The recommendations of Guideline for Emergency Management of Anaphylaxis answered 15 clinical questions about diagnosis,preparation for treatment,treatment measures,and post-treatment management of anaphylaxis and a total of 26 recommendations were formed.In the recommendations,the quality of evidence was divided into 4 levels:high,moderate,low,and very low.And the strength of recommendation was divided into 2 levels:strong and weak.The strength of recommendations was mainly determined by weighing the advantages and disadvantages,instead of relying on the quality of evidence.Emergency management of anaphylaxis in clinical practice could be carried out with reference to the recommendations of this guideline.