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 observe the changes in visual function and retinal structure in patients with non-arteritic anterior ischemic optic neuropathy(NAION)at different stages and analyze the correlation between visual function and structural indicators.Methods A retrospective study was conducted on 33 patients(33 eyes)with NAION presented within 3 weeks of onset.Changes in visual function[best corrected visual acuity(BCVA),visual field mean deviation(MD),pattern standard deviation(PSD),and visual field index(VFI)]and retinal structure[peripapillary retinal nerve fi-ber layer(pRNFL)]thickness,macular ganglion cell complex(mGCC)thickness and loss volume,and radial peripapillary capillary(RPC)density)were analyzed from 4 to 12 weeks of onset and over 12 weeks of onset.The change features of and correlation between visual function indicators and structural indicators were analyzed.Results The BCVA of NAION eyes exhibited significant improvement with disease progression(P=0.021),with a statistically significant difference be-tween onset＞12 weeks and onset≤3 weeks(P=0.020)and no statistically significant difference between onset≤3 weeks and onset from 4 to 12 weeks or between onset from 4 to 12 weeks and onset＞12 weeks(P=0.158 and 0.100).There were no significant differences in MD,PSD and VFI across different stages of NAION(P=0.419,0.767 and 0.134).The pRNFL thickness(average,superior,and inferior),RPC density(average,superior,and inferior),and mGCC thick-ness(average,superior,and inferior)significantly decreased with disease progression(all P＜0.001),while focal loss volume(FLV)and global loss volume(GLV)of mGCC significantly increased with disease progression(both P＜0.001).The differences in these indicators above among each stage were statistically significant(all P＜0.05).Correlation analysis revealed that the BCVA demonstrated positive correlations with mGCC thickness(average and inferior)and RPC density(average and inferior)(all P＜0.05).Conversely,it exhibited negative correlations with FLV and GLV(both P＜0.05).There were no correlations between BCVA and pRNFL thickness(average,superior,and inferior),superior mGCC thick-ness,and superior RPC density(all P＞0.05).MD and VFI showed positive correlations with mGCC thickness(average and inferior)and RPC density(average,superior,and inferior)(all P≤0.001)and negative correlations with GLV(both P＜0.001),but no correlations with pRNFL thickness(average,superior,and inferior),superior mGCC thickness,and FLV(all P＞0.05).PSD showed no correlations with pRNFL thickness(average,superior,and inferior),mGCC thickness(average,superior,and inferior),FLV,GLV,and RPC density(average,superior,and inferior)(allP＞0.05).Conclu-sion The changes in visual acuity and visual field with the progression of NAION are associated with changes in mGCC thickness and RPC density,but not correlated with changes in pRNFL thickness.This suggests that visual function and reti-nal structural changes do not occur synchronously.

ObjectiveTo explore the therapeutic mechanism of Bushen Huoxue prescription from the perspective of bone metabolism by observing the clinical efficacy of this prescription in treating femoral head necrosis （ONFH， syndrome of liver and kidney deficiency） and its influences on bone metabolism indexes： N-terminal propeptide （PINP） and β-collagen degradation product （β-CTX）. MethodSixty-six ONFH patients with the syndrome of liver and kidney deficiency in Zhengzhou Traditional Chinese Medicine Hospital of Orthopedics from December 2021 to September 2022 were selected. The patients were randomized into an experimental group and a control group by the parallel control method， with 33 patients in each group. The experimental group received Bushen Huoxue prescription orally， while the control group received Xianlinggubao Capsules orally， with a treatment cycle of 6 months. The visual analogue scale （VAS） score， Harris score， Association Research Circulation Osseous （ARCO） staging， imaging changes， quantitative scores of TCM symptoms， and serum levels of PINP and β-CTX were determined before and after treatment. The occurrence of adverse events and reactions was recorded. ResultThe total response rate in the experimental group was 83.87% （26/31）， which was higher than that （68.75%， 22/32） in the control group （Z=-2.096， P<0.05）. After treatment， the single and total scores of TCM symptoms， VAS score， and β-CTX level decreased in the two groups （P<0.05）. Moreover， the decreases in the scores of hip pain， lower limb mobility， soreness of waist and knees， and lower limb flaccidity， total score of TCM symptoms， VAS score， and β-CTX level in the experimental were larger than those in the control group （P<0.05）. After treatment， the imaging results showed no significant improvement in the two groups. The Harris score and PINP level in both groups increased after treatment （P<0.05）， and the increases were more obvious in the experimental group than in the control group （P<0.05）. No serious adverse event or adverse reaction appeared during the observation period. ConclusionBushen Huoxue prescription can relieve pain and TCM symptoms and improve the hip joint function in treating ONFH patients with the syndrome of liver and kidney deficiency. It can inhibit the development of ONFH， increase PINP， and decrease β-CTX. No obvious side effect appears during the clinical observation period， which shows that Bushen Huoxue prescription has good safety.

With the rapid development of the interdisciplinary area of artificial intelligence and medicine, large language model (LLM) has been widely used in the fields such as diagnosis and treatment, medicine, and healthcare. LLM has unique advantages in the field of traditional Chinese medicine (TCM), such as high consistency with the "Four Diagnostic Methods", perfect combination of natural language and self-supervised learning in TCM, the ability to adapt to the characteristics TCM formulas, and the assistance in TCM diagnosis and treatment. At present, various LLM models have been developed, including the "Qihuang Ask Big Model" and the Digital Traditional Chinese Medicine Big Model "GLM-130B", but they still face challenges such as value mismatch and medical abuse, increased demand for interpretability, lack of advanced technology, and domestic policy access. This article reviews the evolution of LLM, its unique advantages and applications in the field of TCM, the problems and challenges, and the future development trends, in order to providereference for the further promotion of LLM in traditional medicine.

Objective To investigate the role of macrophages in the process of fine particulate matter (PM2.5)exposure induced damage to pulmonary blood-air barrier.Methods Eighteen male BALB/C mice (aged of 10 weeks,weighing 24～27 g)were randomly divided into control group and low-and high-dose PM2.5 exposure groups (receiving 1 .8 and 16.2 mg/kg,respectively),with 6 mice in each group.The control group received tracheal instillations of normal saline on days 1,4,and 7,whereas the exposure groups were administered corresponding dose of PM2.5 exposure at the same time points.In 24 h after last exposure,pathological changes in the lung tissues were observed,and the contents of total protein (TP ),lactate dehydrogenase (LDH ),and alkaline phosphatase (AKP ) in bronchoalveolar lavage fluid (BALF ),and F4/80 protein level in lung tissue were measured to evaluate the blood-air barrier damage and macrophage infiltration within the lung tissues.Additionally,an in vitro model of the blood-air barrier was established using A549 alveolar epithelial cells and EA.hy926 vascular endothelial cells.In combination with a THP-1 macrophage model,the supernatant PM2.5 supernatant,macrophage supernatant,and PM2.5-macrophage supernatant were incubated with the barrier model for 24 h,respectively.Transmembrane electrical resistance (TEER),sodium fluorescein permeability of the barrier model,and LDH release from the barrier cells were measured to ascertain the extent of macrophage-mediated enhancement in barrier damage induced by PM2.5 exposure.Furthermore,the expression of inflammatory cytokines,such as TNF-α,IL-1β,IL-6,and IL-8 in the macrophages after PM2.5 exposure was analyzed with quantitative real-time PCR (qPCR)and enzyme-linked immunosorbent assay (ELISA).Results PM2.5 exposure induced lung tissue damage in mice in a dose-dependent manner,significantly elevated the contents of TP,LDH and AKP in the BALF and caused marked infiltration of macrophages into the lung tissue,especially the high-dose exposure when compared with the mice from the control group (P<0.01 ).In vitro barrier model exposure experiments showed that in comparison with the treatment of 150 and 300 μg/mL PM2.5 and macrophage supernatant,the same doses of PM2.5-macrophage supernatant resulted in notably decreased TEER and significantly enhanced permeability in the barrier model (P<0.01 ),and markedly increased LDH release from epithelial and endothelial barrier cells (P<0.01 ).Additionally,the exposure of 150 and 300μg/mL PM2.5 led to a significant up-regulation of TNF-α,IL-1β,IL-6,and IL-8 in the macrophages (P<0.01 ).Conclusion Macrophages deteriorate PM2.5-induced functional impairment of the pulmonary blood-air barrier.

Noninfectious uveitis (NIU) is a refractory disease that could lead to blindness.Lack of specific NIU indicators sometimes causes a delay in diagnosis and treatment, due to its diverse etiology, complex mechanism, and the long course of disease.Empirically, the clinical emphasis is to optimize diagnosis and treatment methods and reduce complications.Recent studies on exosomes have shown their regulatory effect on inflammation, suggesting that they have application potential in the diagnosis and treatment of uveitis.Exosomes are cell-derived cystic vesicles, containing a variety of effector biomolecules and biomarkers.They can penetrate biological barriers, mediate intercellular communication, and be used as drug carriers in clinical treatment.However, research on exosomes in fundus diseases, especially in uveitis, is still in its infancy.This article reviews advanced research, hypothesis, and possible translational applications of exosomes in NIU to provide new ideas for the diagnosis and treatment of the disease.

Objective:To explore the effect of Jian-Pi-Zhi-Dong decoction on autonomous activity and dopamine (dopamine, DA) synaptic vesicle protein expression in the striatum of Tourette syndrome (TS) model rats.Methods:The 4-week-old male SD rats were used to establish the TS model by intraperitoneal injection of N-aminodipropionate. Thirty successfully modeled rats were randomly divided into model group, Chinese medicine group, and tiberide group according to random number table method, with 10 rats in each group. And another 10 rats with matched body mass were selected as the control group. Rats in Chinese medicine group were given Jian-Pi-Zhi-Dong decoction solution (1.6 g/100 g) and the rats in tiapride group were given sulfate tiapride suspension (2.1 mg/100 g), while rats in control group and model group were given an equal volume of 0.9% sodium chloride solution, once a day for 4 weeks.The number of autonomous activities in rats was determined by autonomous activity programmer. ELISA was used to detect the level of DA in the striatum of rats and the expression of dopamine transporter (DAT).Vesicular monoamine transporter-2 (VMAT2) and α-synuclein (α-syn) were measured by Western blot.SPSS 25.0 software was used for data analysis. Multiple group comparisons were performed using one-way ANOVA, non-parametric test and repeated measures ANOVA.Results:Comparing the number of autonomous activities among the 4 groups, the interaction effect between time and group was significant ( F=184.354, P<0.001). At the 1-4 weeks of gavaging, the numbers of autonomic activities in the model group were more than those in the control group (all P<0.05).While the numbers of autonomic activities in Chinese medicine group and tiapride group were less than those in the model group (all P<0.05). Moreover, the numbers of autonomic activities in Chinese medicine group and tiapride group from 1 to 4 weeks were less than those after model making (all P<0.05). The Western blot results showed significant differences in the relative expression of α-syn ( H=29.098), DAT ( F=54.632) and VMAT2 ( H=18.982) among the 4 groups (all P<0.001). The expression levels of α-syn protein in Chinese medicine group and tiapride group were both lower than that in the model group (0.39(0.36, 0.51), 0.39(0.36, 0.50), 0.62(0.50, 0.70)) (both P<0.05). The expression level of DAT protein in Chinese medicine group was higher than that in the model group and lower than that in tiapride group ((0.37±0.06), (0.26±0.07), (0.49±0.09)) (both P<0.05). And the expression level of VMAT2 protein in Chinese medicine group had no significant difference compared with that in the model group ( P>0.05).The ELISA results showed significant differences in DA content of striatum among the 4 groups ( F=75.370, P<0.001). The level of DA in the model group was higher than that in the control group ((7.65±0.72) ng/L, (3.71±0.59) ng/L, P<0.05). The levels of DA in Chinese medicine group ((3.92±0.81) ng/L) and tiapride group ((4.40±0.53) ng/L) were lower than that in the model group (both P<0.05), and the difference between Chinese medicine group and tiapride group was not significant ( P>0.05). Conclusion:Jian-Pi-Zhi-Dong decoction can relieve the tic symptoms of the model rats with TS, and its mechanism may be related to inhibiting the excessive release of α-syn, improving the expression of DAT and VMAT2, improving the DA synaptic vesicle circulation, and reducing the DA content in the synaptic space of the brain.

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 analyze the incidence and risk factors of postoperative pulmonary complications(PPCs)in elderly patients undergoing video-assisted thoracoscopic surgery(VATS).Methods Elderly patients aged≥65 years who underwent VATS in Peking Union Medical College Hospital from January 2013 to December 2017,were reviewed retrospectively and divided into non-PPCs group and PPCs group.General information,past medi-cal history,and postoperative complications were recorded in a uniform case report form.The clinical factors with statistical significance in univariate analysis and important clinical significance according to experience were ana-lyzed with Logistic regression to evaluate the independent risk factors for PPCs.Results A total of 900 patients were included,and 48(5.3%)of them suffered PPCs.Multivariate logistic regression showed that pre-operative smoking history,history of stroke,chronic obstructive pulmonary disease(COPD)and pulmonary lobectomy were independent risk factors for PPCs in elderly patients after VATS.Conclusions Elderly patient is a high-risk group for PPCs after VATS.The risk factors include smoking history,stroke,COPD and scope of surgery.Therefore,perioperative management needs to optimize,and monitoring should be strengthened for these high-risk patients.

Objective:To investigate the cognition and clinical practice status of Enhanced Recovery After Surgery (ERAS) among anesthesiologists in secondary hospitals in China using a questionnaire, trying to provide some references for the promotion and popularization of ERAS across China.Methods:From April to November 2021, anesthesiologists in secondary public hospitals across the country were enrolled by convenience sampling and investigated by a self-designed questionnaire on the cognition, clinical practice status and their teaching needs about ERAS.Influencing factors of ERAS cognition were then analyzed.Results:Totally 879 questionnaires were sent out, 864 were effectively received with effective recovery of 98.3%.The anesthesiologists in this survey were distributed in 31 provincial administrative regions across the country.The score of the ERAS cognition (total score of 18) was 12.00 (3.75), and 563 participants (65.2%) were qualified on cognitive status (score ≥ 12). Geographic region, age, educational qualification, professional title and length of occupation were found to have significant influence on ERAS cognition ( P<0.05). Among the anesthesiologists who participated in the survey, 817 participants (94.6%) recognized that ERAS management was beneficial to patients, and 778 (90.0%) of them agreed that ERAS management should be carried out as much as possible in secondary hospitals.Two hundred and fifty-five (29.5%) participants had never implemented ERAS management in clinic anesthesia.There were significant differences in the ERAS practice status among participants from different geographical regions in China ( P<0.05). Eight hundred and forty-eight (98.1%) anesthesiologists who participated in the survey expressed their willingness to receive further systematic training on ERAS, and taking online courses and reading books were the current main ways to obtain related knowledge. Conclusions:The cognition and clinical practice status of ERAS need to be improved among anesthesiologists in secondary hospitals in our country.Sustained ERAS education programs with various forms should be carried out in subgrade medical care centers in order to continuously promote the extensive practice of ERAS across China.