To evaluate the reliability of flash continuous glucose monitoring(CGM) and itsaccuracy in supporting clinical decision-making after pancreatic surgery.

The gut microbiota is generally thought in regulating the body's metabolism and immune function.The imbalance of gut microbiota is related to the occurrence and development mechanisms of acute and chronic lung dis-eases,resulting from lung injury.The"gut-lung axis"pays a main role in various ways in the occurrence of lung injury,including intestinal barrier dysfunction,reduced diversity of gut microbiota,decreased secretion of beneficial metabolites,translocation of gut microbiota and metabolites to the lungs,immune damage to the body and lungs,increased inflammatory response in the lungs.

Valvular heart disease(VHD)is a common type of heart disease in adults,with approximately 80 000 VHD surgeries performed annually in China.As the population ages,the number of VHD patients is expected to further increase.To standardize perioperative management of VHD surgeries and improve patient survival and quality of life,the Cardiovascular Anesthesia Committee of the Chinese Society of Cardiothoracic and Vascular Anesthesiology,in collaboration with the Professional Committee of Anesthesiology,National Expert Committee for Cardiovascular Diseases and Anesthesiology Branch of Beijing Medical Association organized a multidisciplinary expert panel develop current consensus.Following the principles and standards for developing clinical practice guidelines,the panel formulated the expert consensus on perioperative management of adult valvular heart disease surgery(2025).This consensus addresses 6 key clinical aspects of adult VHD surgery:preoperative evaluation,perioperative monitoring,intraoperative management,blood conservation,perioperative analgesia,and perioperative management of transcatheter valve intervention.Based on the best available evidence and expert consensus,21 recommendations are formulated to guide perioperative management in VHD surgeries in China.

Valvular heart disease(VHD)is a common type of heart disease in adults,with approximately 80 000 VHD surgeries performed annually in China.As the population ages,the number of VHD patients is expected to further increase.To standardize perioperative management of VHD surgeries and improve patient survival and quality of life,the Cardiovascular Anesthesia Committee of the Chinese Society of Cardiothoracic and Vascular Anesthesiology,in collaboration with the Professional Committee of Anesthesiology,National Expert Committee for Cardiovascular Diseases and Anesthesiology Branch of Beijing Medical Association organized a multidisciplinary expert panel develop current consensus.Following the principles and standards for developing clinical practice guidelines,the panel formulated the expert consensus on perioperative management of adult valvular heart disease surgery(2025).This consensus addresses 6 key clinical aspects of adult VHD surgery:preoperative evaluation,perioperative monitoring,intraoperative management,blood conservation,perioperative analgesia,and perioperative management of transcatheter valve intervention.Based on the best available evidence and expert consensus,21 recommendations are formulated to guide perioperative management in VHD surgeries in China.

To improve the current situation of multiple preoperative visits and evaluations for elderly patients and other patients with complex conditions, in December 2022, Peking Union Medical College Hospital established preoperative multidisciplinary evaluation clinic (shorted as joint clinic). The joint clinic established a multidisciplinary team, clarified service targets, and developed standardized clinic workflows to provide patients with a " one-stop" preoperative assessment(physical fitness assessment, nutritional assessment, and frailty assessment, etc.), nutritional optimization intervention, and prerehabilitation education and guidance services. This practice strengthened preoperative risk management, improved preoperative assessment efficiency, and ensured the safety of patients during the perioperative period. As of September 2023, the joint clinic had received a total of 128 patients, of which 86 underwent surgery after preoperative evaluation and prehabilitation optimization. The obesity rate, smoking rate, and number of frailty cases of these patients had decreased from 13.96%, 11.63%, and 18 at the time of visit to 9.30%, 4.65%, and 14 on the day before surgery, respectively. They had recovered well after surgery. This practice had improved the preoperative status of patients and created conditions for high-risk patients to undergo surgery smoothly, so as to provide references for other hospitals to carry out multidisciplinary collaborative preoperative evaluation works.

Objective:To develop college students' proactive aggression questionnaire (CPAQ) and test its reliability and validity.Methods:From March 2023 to April 2024, a questionnaire survey was conducted among 1 552 college students(618 individuals in Sample 1, 783 individuals in Sample 2, 151 individuals in Sample 3 (retested after a 6-month interval), and 49 individuals in Sample 4 (randomly selected from Sample 3)).The reliability and validity of CPAQ were assessed using SPSS 24.0 and Mplus 8.3 software through item analysis, exploratory factor analysis, confirmatory factor analysis, internal consistency reliability, test-retest reliability, compatibility validity, discriminant validity, and empirical validity.Results:The results of the project analysis showed that the 33 items in the CPAQ were significantly correlated with the total score( r=0.25-0.78, P<0.05), and item scores between the high and low group were significantly different (all P<0.001). Exploratory factor analysis retained 28 items, which belonged to three dimensions of proactive aggression (instrumental motivation, moral inhibition, and moral disengagement). The results of confirmatory factor analysis showed that the three-dimensional model of the questionnaire was well fitted ( χ2/ df=3.25, CFI=0.96, TLI=0.95, RMSEA=0.05, SRMR=0.06). The Cronbach's α coefficients for the total score of CPAQ and its sub dimensions were 0.93, 0.95, 0.89 and 0.75, respectively(all P<0.05). The test-retest reliability was 0.64, 0.63, 0.67 and 0.60, respectively(all P<0.01). In the compatibility validity test, the instrumental motivation dimension score was positively correlated with the proactive aggression dimension score of reactive-proactive aggression questionnaire(RPQ)( r=0.50, P<0.05), while moral inhibition dimension was negatively correlated with empathy and guilt scores( r=-0.30, -0.39, P<0.05). The dimension of moral disengagement was positively correlated with the score of the moral disengagement scale( r=0.58, P<0.05). In the discriminant validity test, the correlation of CAPQ and RPQ reactive aggression dimension score was not significant( r=0.08, P=0.16). In the criterion related validity test, the correlation coefficients between the score of CAPQ and each calibration questionnaire and scale were 0.70-0.83. In the empirical validity test, there was a significant difference in the different CPAQ score groups for proactive aggressive behavior(high group: (1.16±0.18), low group: (1.04±0.08), t=2.60, P<0.05). Conclusion:CPAQ has good discrimination, reliability, and validity, which could be used as a tool to measure proactive aggressive behavior among college students.

Objective To investigate clinicians'practice and opinions on sedation therapy in end-stage patients at Peking Union Medical College Hospital.Methods From August,2022 to April,2023,an online questionnaire survey was conducted among clinicians involved in end-stage patient management.Results A total of 205 questionnaires were distributed,with an effective response rate of 56.1% .Among the clinicians,55.7% of them had experience of applying sedation therapy in end-stage patients;85.2% of clinicians believed that se-dation could relieve the suffering of terminal patients from physical refractory symptoms;75.7% of clinicians considered that sedation therapy could be used to relieve agony from psycho-existential distress.Most clinicians had concerns about sedation therapy due to the lack of legal support(86.1% )and the lack of understanding of patients or families(59.1% ).The majority(90.4% )of clinicians were willing to receive training on palliative sedation.Conclusions A majority of clinicians agree that sedation therapy could relieve the physical distress and psycho-existential distress in end-stage patients.However,most clinicians have concerns about the application of sedation therapy due to the lack of legal support.It is necessary to enhance the training on palliative sedation.

Objective To explore the practice and significance of the new course of"Enhanced Recovery after Sur-gery(ERAS)and Perioperative Management"for graduate students under multidisciplinary cooperation.Methods The Department of Anesthesiology collaborated with the Department of Clinical Nutrition,Department of Geriatrics and six related surgical departments to develop a course of 30 credit hours on"ERAS and Perioperative Manage-ment"in Peking Union Medical College Hospital.Researchers analyzed the teaching effectiveness of the course by collecting survey questionnaires and evaluating scheme report of ERAS case.Results Researchers found that ten graduates joined this course and they believed that learning improved their understanding of ERAS related knowl-edge,such as preoperative nutrition and functional state optimization,intraoperative volume and temperature man-agement,prevention of postoperative nausea and vomiting,and perioperative pain management.Students had high satisfaction with the course and believed that it would help improve their clinical literacy.Conclusions The new course of"ERAS and Perioperative Management"for graduates may support capacity building in terms of clinical logic and thinking about ERAS and promotion of skills for perioperative management.Our experience of graduates′training with"Enhanced Recovery after Surgery and Perioperative Management"course can be shared by other trainers of health institution of China.

OBJECTIVE To explore the potential mechanism of the effect of Xuebijing injection （XBJ） on neurological function and survival of rats after cardiac arrest （CA）/cardiopulmonary resuscitation （CPR） based on the S-nitrosoglutathione reductase （GSNOR）/S-nitrosoglutathione （GSNO） pathway. METHODS The CA/CPR rat model was established by ventricular fibrillation. Using a sham operation group as control， high-throughput sequencing was employed to analyze and mine the differentially expressed genes （DEGs）. Enzyme-linked immunosorbent assay was used to determine the contents of GSNOR and GSNO in the hippocampus； the active components of XBJ were screened and subjected to molecular docking analysis with GSNOR. The rats successfully modeled using the same method were divided into model group （n＝30）， inhibitor （GSNOR inhibitor） group （n＝30）， XBJ group （n＝30） and XBJ+inhibitor group （n＝30）， and a sham operation group （n＝30） was set up. Neurological function was evaluated and survival status was recorded at 3 hours， 24 hours and 3 days after the first 89） drug intervention. The contents of GSNOR and GSNO in the hippocampus of rats were determined in each group at the 0191） above time points， and the relationship of the contents of GSNOR and GSNO with modified neurologic severity scale （mNSS） score was analyzed. RESULTS GSNOR coding gene was differentially expressed between the model group and the sham operation group. Compared with the sham operation group， GSNOR content increased significantly in the hippocampus of rats in model group， while GSNO content decreased significantly （P＜0.05）. The active components of XBJ， such as 4- methylenemiltirone and salviolone， could be bound to GSNOR protein， with the binding energy lower than －6 kcal/mol， mainly connected by hydrogen bonds. Animal experiments revealed that mNSS score and GSNOR levels in the hippocampus of rats in the model group were significantly higher than those in the sham operation group （P＜0.05）， while GSNO levels and survival rate were significantly lower than those in the sham operation group （P＜0.05）. The above indexes of rats were improved significantly in administration groups， the mNSS score in the XBJ group was significantly lower than that in the inhibitor group， the content changes of GSNOR and GSNO in the inhibitor group were more obvious than those in the XBJ group， and the various indicators in the XBJ+inhibitor group were significantly better than the XBJ group and the inhibitor group （P＜0.05）. GSNOR content was positively correlated with the mNSS score， and GSNO content was negatively correlated with the mNSS score （P＜0.05）. CONCLUSIONS XBJ can improve the neurological function of rats and enhance their survival rates after CA/CPR， the mechanism of which may be associated with the down-regulation of GSNOR and the up-regulation of GSNO.

  Objective  This study aimed to investigate Chinese anesthesiologists' comprehension of palliative care and their experiences with palliative sedation for patients in the end-stage of life.  Methods  From October to December 2021, a national cross-sectional survey was conducted among anesthesiologists in China distributed by the Chinese Society of Anesthesiology, Chinese Medical Association with convenient sampling. The survey questionnaire encompassed general information, professional experience, familiarity with palliative care, emotional responses to end-stage cases, experience with sedation for critically ill or end-stage patients, and preferences for sedation medication.  Results  A total of 2536 anesthesiologists from 29 provinces in China completed valid questionnaires. Among them, 572 anesthesiologists(22.6%, 572/2536) reported familiarity with palliative medicine. Male anesthesiologists, as well as those with prior experience in caring for critically ill or end-stage patients, involved in pain management and practicing in hospitals with established institutional palliative care teams, demonstrated greater familiarity with palliative care concepts(all P<0.05). Over 40% of respondents felt powerless, helpless, and indecisive when confronted with end-stage patients. Anesthesiologists knowledgeable about palliative care exhibited greater confidence in managing critically ill or end-stage patients(9.8% vs. 4.4%, P=0.001). Among the anesthesiologists surveyed, 734 had administered sedation to end-stage patients, with 151 of them(20.6%, 151/734) inappropriately relying solely on opioids for sedation.  Conclusions  The understanding of palliative care and palliative sedation medication choice among anesthesiologists in China is still very limited. The establishment of palliative care teams, provision of education and training in palliative care, and enhancement of familiarity with palliative principles may bolster anesthesiologists' confidence when encountering critically ill or end-stage patients and subsequently enhance the quality of care for patients in the terminal stages of life.