Objective Using our team's recent research achievement"the cervical ultrasound scanning route map"as a teaching tool,to evaluate its impact on the learning effectiveness and confidence of beginners in the process of learning cervical spinal ultrasonography.Methods This study is a before and after self-control study.After recruit-ment of 40 cervical ultrasound beginners,they had completed questionnaire 1.The questionnaire was designed with three self-assessment questions on theoretical knowledge of cervical spinal ultrasound,three self-assessment ques-tions on practical skills of cervical spinal ultrasound and one question on willingness to use cervical spinal ultra-sound in the future.After traditional teaching without involving the route map,beginners completed questionnaire 2 with the same content.After a 20 min break,teacher introduced and explained the route map to the beginners,then the beginners completed questionnaire 3.Questions related to satisfaction with this learning experience had been added to questionnaire 3.The answers to all questions were scored on a scale of 1-10.In this study,the main out-come was the comprehensive learning score,calculated as(sum score of theoretical knowledge+sum score of prac-tical skills+score of willingness to use cervical ultrasound in the future)/7.Results Beginners'comprehensive learning score at the three time points were 2.9±1.3,4.8±1.8,5.7±1.8,F(2,22)= 52.11,P＜0.001,partial Eta squared=0.83.After introducing the route map,their comprehensive learning score increased 1.0(95%CI:0.46-1.49)(P＜0.001)compared to scores after traditional training.Conclusions The route map may significantly improve learning effectiveness and confidence of beginners in the field of cervical spinal ultrasonography and can be used as a routine training tool in the teaching of cervical spinal ultrasonography.

Objective To investigate the knowledge,clinical application and training needs of Chinese anesthesiologists for ultrasound-guided intrathecal puncture technique.Methods The survey objects were anesthesiology clinicians in China.The questionnaire was designed by ourselves,and the survey time was from October to November 2023.Questionnaires were sent through wechat platform.The questionnaire was divided into three parts:general demographic information,application of intraspinal puncture,application of intraspinal puncture under ultrasound guidance,and training needs for intraspinal puncture under ultrasound guidance.The influencing factors were analyzed by ordered Logistic regression.Results A total of 1001 questionnaires were collected with a valid ratio was 94.2％(942/1 001).The respondents'knowledge of ultrasound-guided intrathecal puncture was 3.21±1.03,while the clinical application level was 2.43±1.25(P＜0.01).According to ordinal logistic regression analysis,senior doctor(OR=0.312,95％CI0.117-0.829,P=0.019),male(OR=0.658,95％CI 0.511～0.846,P=0.001),central region(OR=0.690,95％CI 0.523-0.911,P=0.009)and percentage of neuraxial anesthesia less than 20％(OR=0.426,95％CI 0.200-0.905,P=0.026)were significantly negatively correlated with the knowledge of ultrasound-guided intrathecal puncture technique.The main obstacle for the clinical application was unfamiliarity of the technique(83.9％)and the equipment(54.6％).The key technical challenges were finding the correct ultrasound views(69.6％),recognizing anatomical structures(69.2％)and poor ultrasound imaging(63.0％).The preferred training methods were simulation training(87.4％)and clinical instruction based on cases(90.0％).Conclusion There is still room for improvement in the understanding and clinical application of ultrasound-guided intrathecal puncture technique for the Chinese anesthesiologists.In the future,more training on ultrasound-guided intrathecal puncture technique could be provided according to our survey.

A middle-aged male came to Peking Union Medical College Hospital for treatment because of "pain for 10+ years, aggravated with emotional instability for 5 years". The patient's pain had a huge impact on life, with poor results even after repeated diagnosis and treatment in other hospitals. After multi-disciplinary discussion, it had been clarified that the pain was mainly caused by gout. The disease was heavily influenced by psychosocial factors. Therefore, the patient fits the diagnosis of "Psychological and Behavioral Factors Affecting Physical Diseases". The multi-disciplinary comprehensive management of the patient was carried out to identify and treat psychological factors affecting other medical conditions. After this mental treatment was performed, the patient's conditions significantly improved. The diagnosis and treatment of this patient demonstrates the importance of the multi-disciplinary treatment team for somatic symptoms (disorders).

Objective:To evaluate the effects of 3D printing and mixed reality (MR) in teaching ultrasound-guided spinal puncture for scoliosis and to provide new approaches for enhancing educational outcomes in this field.Methods:Twenty anesthesiologists with no experience of spine ultrasound were selected from the Department of Anesthesiology at Peking Union Medical College Hospital and received training in ultrasound-guided spinal puncture in March 2024. They were assigned to the MR glasses+3D printing group or 3D printing group, with 10 participants in each group. The trainees in the MR glasses+3D printing group observed the spine model with the HoloLens 2 glasses and then conducted ultrasound-guided spinal puncture on the 3D-printed spine model. The trainees in the 3D printing group directly conducted ultrasound-guided spinal puncture on the 3D-printed spine model. The teaching effects were evaluated with objective puncture indicators (success rate and puncture time) and questionnaire survey. Data were analyzed using the independent samples t-test or chi-square test in SPSS 27.0. Results:The puncture time was shorter in the MR glasses+3D printing group compared with the 3D printing group [(165.90±69.91) s vs. (239.30±80.30) s, t=2.18, P=0.043]. The success rate of spinal puncture was 90.00% (9/10) in the MR glasses+3D printing group and 80.00% (8/10) in the 3D printing group, with no statistically significant difference ( P>0.999). The satisfaction [(4.70±0.48) vs. (4.80±0.42), t=0.49, P=0.628] and recommendation [(4.80±0.42) vs. (4.90±0.32), t=0.60, P=0.556] of the training method showed insignificant differences between the MR glasses+3D printing group and the 3D printing group. Conclusions:The combination of 3D printing with MR technology can provide trainees with a safe and repeatable high-fidelity simulation training system for ultrasound-guided spinal puncture. The system can improve the confidence and interest of trainees in ultrasound-guided spinal puncture techniques and enhance training efficiency. This combination demonstrates advantages and potential in training for spinal ultrasound and ultrasound-guided spinal puncture.

Objective:To evaluate the effects of 3D printing and mixed reality (MR) in teaching ultrasound-guided spinal puncture for scoliosis and to provide new approaches for enhancing educational outcomes in this field.Methods:Twenty anesthesiologists with no experience of spine ultrasound were selected from the Department of Anesthesiology at Peking Union Medical College Hospital and received training in ultrasound-guided spinal puncture in March 2024. They were assigned to the MR glasses+3D printing group or 3D printing group, with 10 participants in each group. The trainees in the MR glasses+3D printing group observed the spine model with the HoloLens 2 glasses and then conducted ultrasound-guided spinal puncture on the 3D-printed spine model. The trainees in the 3D printing group directly conducted ultrasound-guided spinal puncture on the 3D-printed spine model. The teaching effects were evaluated with objective puncture indicators (success rate and puncture time) and questionnaire survey. Data were analyzed using the independent samples t-test or chi-square test in SPSS 27.0. Results:The puncture time was shorter in the MR glasses+3D printing group compared with the 3D printing group [(165.90±69.91) s vs. (239.30±80.30) s, t=2.18, P=0.043]. The success rate of spinal puncture was 90.00% (9/10) in the MR glasses+3D printing group and 80.00% (8/10) in the 3D printing group, with no statistically significant difference ( P>0.999). The satisfaction [(4.70±0.48) vs. (4.80±0.42), t=0.49, P=0.628] and recommendation [(4.80±0.42) vs. (4.90±0.32), t=0.60, P=0.556] of the training method showed insignificant differences between the MR glasses+3D printing group and the 3D printing group. Conclusions:The combination of 3D printing with MR technology can provide trainees with a safe and repeatable high-fidelity simulation training system for ultrasound-guided spinal puncture. The system can improve the confidence and interest of trainees in ultrasound-guided spinal puncture techniques and enhance training efficiency. This combination demonstrates advantages and potential in training for spinal ultrasound and ultrasound-guided spinal puncture.

Objective To investigate the anesthesia residents' proficiency in the epidural puncture and training needs using questionnaire survey in China.Methods A questionnaire designed by ourselves was sent to anesthesia residents via the WeChat platform within 1 month.The data were recorded by the system automatically.Results A total of 795 anesthesia residents involved in the investigation,and the number of valid questionnaires was 753 (94.7％).There were 233 (30.9％) junior residents (0-2 yr of training),279 (37.1％) semi-senior residents (3-5 yr of training),and 241 (32.0％) senior residents (＞5yr of training).Compared with junior group,the difficulty score for epidural puncture was significantly decreased,and the confidence scores for performing normal middle lumbar,difficult lumbar,lateral lumbar and thoracic epidural puncture were increased in semi-senior and senior groups (P＜0.05).Compared with semi-senior group,the difficulty score for epidural puncture was significantly decreased,and the confidence scores for performing normal middle lumbar,difficult lumbar,lateral lumbar and thoracic epidural puncture were increased in senior group (P＜0.05).The self-evaluated difficulty of epidural puncture was lower as the number of prior epidural cases was more (r=-0.719,P＜0.01).There were 46.6％ of the residents who had received simulation-based training before performing epidural puncture on the patient,among which most residents considered the simulation-based training is effective in helping to familiarize with procedure (77.2％),familiarize with anatomy (70.4％),simulate the texture of different layers (47.9％),and enhance success rate of epidural puncture (56.7％).There were 75.0％ residents who considered visualization technology is helpful in enhancing the success rate and confidence of epidural puncture.Conclusion Currently,the proficiency of junior anesthesia residents in epidural puncture needs to be strengthened.The simulation-based training has not been widely applied in the epidural training,while residents think high of simulation-based training and are looking forward to visualization technique training.

Objective To compare simulated training of "45° tilting insertion" and the "dynamic scan" needling under B ultrasound.Methods Fifty volunteer residents and visiting physicians worked in the anesthesiology department in Peking Union Medical College Hospital were recruited to attend the simulated needling training.The insertion time,insertion attempts until success,numbers of success while advancing the needle and numbers of needle tip visible upon success were re corded.The degree of difficulty and safety of the techniques,the confidence of performing the techniques,the clinical usefulness of the techniques and the training effect were evaluated among the volunteers.Results There were no differences in the insertion time,numbers of successful insertion while advancing the needle and numbers of needle tip visible upon success between the two techniques.Compared with "45° tilting insertion" technique,"dynamic scan" resulted in less needle redirection times and a higher first-attempt successful rate,and got higher scores in terms of difficulty and safety (P＜0.05 or P＜0.01).The confidence scores of performing the two technique were similar.20 (40％) volunteers chose to use "dynamic scan",8 (16％) chose to use "45° tilting insertion" and 22 (440％) chose to use both technique in their clinical work.100％ of them considered the training was greatly helpful or helpful.Conclusion The technique of "dynamic scan" produced a higher first-attempt successful rate and was easier and safer than "45° angle insertion".The combination of the two techniques might be a new technique that is worth trying.

Objective To study clinical data retrospectively and demonstrate the optimal injection site of adductor canal block by performing a cadaveric study.Methods Clinical part:clinical data from 19 patients,11 males and 8 females,aged 21 85 years,ASA physical status Ⅰ-Ⅲ,who received ultrasound guided adductor canal block were retrospectively collected.Among whom 9 received a mid-distance injection of 10 ml of 0.5％ ropivacaine and 10 received an injection of the same medication at the outlet of adductor canal.The primary endpoint was complete absence of cold sensation to ice cube on the medial side of calf at 30 minutes and 24 hours after injection.Cadaveric part:40 lower limbs,20 males and 20 females,were finally analyzed in the study.The distances from the anterior superior iliac spine (ASIS) to the medial tibial condyle,from ASIS to the entrance of the adductor canal,from ASIS to the exit of the canal (adductor tendinous opening),from ASIS to the site where sa phenous nerve emerges through the aponeurotic covering were measured respectively.The length of adductor canal,the relative location of adductor canal and the site where saphenous nerve pierces in the lower limbs were calculated.Results Clinical part:all 19 cases were successfully recorded with complete absence of cold sensation at 30 minutes after injection of local anesthetic and complete sensory recovery at 24 hours after injection.Cadaveric part:in all specimens,saphenous nerve enters adductor canal and coursed down until emerging at very close to the distal end of the canal with the saphenous branch of descending genicular artery.The length of the adductor canal was (10.0±2.1) cm.The entrance and the exit of adductor canal and the emerging site of the saphenous nerve located along the (54.7±3.0) ％,(76.0％±3.8) ％ and (74.1±3.2) ％ of sartorius muscle,respectively.Conclusion Performing ultrasound-guided adductor canal block at either the outlet of adductor canal or mid-distance of thigh can achieve comparable blockade of saphenous nerve.Cadaveric study implicated that the optimal injection site for adductor canal block should be the lower one-third of sartorius muscle.Ultrasound-guided injection of local anesthetics next to the descending genicular artery may possibly become a promising new method of saphenous nerve block.

Objective To assess Chinese parental requirement for relieving their preoperative anxiety,and their attitudes regarding the measures reducing their anxiety and to investigate the possible factors associated with increased anxiety.Methods One hundred and four pairs of pediatric patients (aged 2-12 yr,of ASA physical status Ⅰ or Ⅱ) undergoing elective surgery under general anesthesia and their parents were enrolled in this study.The general data of the pediatric patients and their parents and parental requirement for relieving their preoperative anxiety,and their attitudes regarding the measures reducing their anxiety were obtained using a questionnaire.Parental and children's anxiety? levels were assessed using the State-Trait Anxiety Inventory (STAI) and modified Yale Preoperative Anxiety Scale (m-YPAS),respectively.Results Parental anxiety levels were positively correlated with the children's anxiety levels (r =0.254).Parental desires to relieve their own anxiety under the personal direction of medical staff were significantly higher than the desires for the other measures; parental desires to relieve their own anxiety through parent-present induction of anesthesia (PPIA) were significantly lower than the desires for the other measures.The factors influencing parental attitudes included gender,educational level,preoperative anxiety level,and preoperative children' s anxiety level.Conclusion To relieve Chinese parental anxiety before surgery,the anesthesiologists should be aware that the majority of parents have a high desire to receive verbal instructions from medical staff before surgery was performed on their children and should provide enough information related to anesthesia and surgery; when PPIA is applied,parental desire for PPIA should be taken into full account; the anesthesiologists offer support and comfort for the parents properly.

d, suggesting that the mutation rate of SDHB gene in sporadic Chinese patients with pheochromocytoma might be around 3%.