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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 recruitment 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 questions on practical skills of cervical spinal ultrasound and one question on willingness to use cervical spinal ultrasound 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 outcome was the comprehensive learning score, calculated as(sum score of theoretical knowledge + sum score of practical 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.

ObjectiveTo explore the incidence and influencing factors of subacute and chronic pain in patients returning to the ICU after surgery, provide diagnostic and therapeutic insights for the evaluation and management of such patients, and improve the prognosis of this population.MethodsPatients who underwent surgical treatment and returned to the ICU from November 29, 2021 to December 31, 2021 at Peking Union Medical College Hospital were prospectively recruited. Subacute and chronic pain incidence and characteristics were assessed by telephone at 1 and 3 months after surgery and the influencing factors were further explored.ResultsA total of 117 patients were enrolled, with an average age of 60.9±16.0 years. The incidence of subacute postoperative pain in patients returning to the ICU after surgery was 45.7%(53/116), and the incidence of chronic postoperative pain in patients returning to the ICU after surgery was 32.7%(36/110). The mean NRS for moderate to severe subacute pain and chronic pain after surgery were(4.9±1.2) and (5.2±1.1), respectively. Multivariable logistic regression analysis showed that coronary artery disease (OR=5.263, 95% CI: 1.436-19.292)was risk factor for chronic postoperative pain in patients returning to the ICU after surgery.ConclusionsPatients returning to the ICU after surgery have a high incidence of postoperative subacute and chronic pain. Coronary artery disease was the risk factor for chronic pain.Perioperative multimodal pain management can be used to improve the pain experience of patients during ICU hospitalization and the short-term and long-term prognosis of patients.

Objective To investigate the occurrence of chronic postsurgical pain (CPSP) among patients with preoperative COVID-19, and further analyze the risk factors for CPSP. Methods This study was a ambispective cohort study, with subjects from a completed cohort study with follow-up. We included the clinical data of the patients with preoperative COVID-19 who underwent surgery at Peking Union Medical College Hospital from December 1, 2022 to February 28, 2023. Follow-up was conducted up to 6 months postoperatively, with the primary outcome being CPSP. Multivariate Logistic regression analysis was used to analyze the correlation between COVID-19-related exposure indicators and CPSP. Results A total of 4117 surgical patients were included, all of whom had preoperative COVID-19. Among them, 4002 cases had mild symptoms during the acute phase, 62 cases had severe symptoms, and 53 cases were critically ill. At 6th month postoperatively, 1298 cases (31.53%) had long COVID-19 syndrome, and the incidence of CPSP was 5.59% (95% CI: 4.88%-6.28%). After adjusting for confounding factors including age, gender, comorbidities, anesthesia method, and type of surgery, multivariate Logistic regression analysis revealed that critically ill COVID-19 during the acute phase (aOR=3.35, 95% CI: 1.48-7.62, P < 0.001) and presence of long COVID-19 syndrome postoperatively (aOR=2.50, 95% CI: 1.90-3.29, P < 0.001) were associated with CPSP. Conclusions It is clear for the first time that critically ill COVID-19 during the acute phase and the presence of long COVID-19 syndrome postoperatively are the risk factors for CPSP among patients with preoperative COVID-19.

Objective To identify the risk factors for postoperative nausea and vomiting (PONV) in surgical patients undergoing patient controlled intravenous analgesia (PCIA). Methods Our study was a retrospective cohort study, including patients who underwent surgery at Peking Union Medical College Hospital from July 1 to October 31, 2023 and received PCIA after surgery. Patient characteristics, medical history, surgical information, intraoperative medication information, postoperative analgesia follow-up information were obtained through the electronic medical record system. The patients were divided into PCIA-PONV group and non-PCIA-PONV group, depending on the occurrence of PONV during PCIA, and all patients were also divided into PCIA-POV group and non-PCIA-POV according to whether postoperative vomiting (POV) occurred. Multivariate Logistic regression analysis was used to identify the risk factors for PCIA-PONV and PCIA-POV. Results A total of 1373 patients were included in this study, with 676 cases in PCIA-PONV group. The incidence of PCIA-PONV was 49.2%. There were 285 patients in PCIA-POV group, and the incidence of PCIA-POV was 20.8%. The results of multivariate Logistic regression analysis showed that female (OR=2.134, 95% CI: 1.590-2.865, P < 0.001) and abdominal surgery (OR=1.655, 95% CI: 1.253-2.186, P < 0.001) were risk factors for PCIA-PONV, whereas the increase of age (OR=0.990, 95% CI: 0.982-0.998, P=0.019) and the increase of BMI (OR=0.961, 95% CI: 0.932-0.991, P=0.012) were protective factors for PCIA-PONV. Female (OR=2.646, 95% CI: 1.754-3.992, P < 0.001), history of general anesthesia (OR=1.372, 95% CI: 1.042-1.806, P=0.024), and intraoperative use of high-dose opioids (OR=1.607, 95% CI: 1.206-2.142, P=0.001) were risk factors for PCIA-POV, whereas no intraoperative use of neuromuscular blocking antagonists (OR=0.393, 95% CI: 0.237-0.651, P < 0.001) was protective factor for PCIA-POV. Conclusions Our study reveals the risk factors for PONV in surgical patients undergoing PCIA, and shows that comprehensive preoperative assessment and reasonable perioperative management strategies are significant in the prevention of PCIA-PONV.

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

To further standardize the clinical diagnosis and treatment decisions of radioiodine refractory differentiated thyroid cancer (RAIR-DTC) in China, it is urgent to establish clinical diagnosis and treatment management guidelines based on evidence-based medical data to scientifically guide the diagnosis and treatment of RAIR-DTC. By referring to the World Health Organization Guidelines Development Manual andfollowing the protocol of devising evidence-based guidelines, we have registered and written the prospectus of Guidelines for the Diagnosis, Treatment, and Management of Iodine Refractory Differentiated Thyroid Cancer. We will also develop and release official guidance documents. This guidelines prospectus mainly introduces the significance, purpose, target population, user population, guidelines formulation team members, collection and determination of clinical issues and outcome indicators, acquisition, evaluation, and synthesis of evidence, as well as generation of recommendations and other guidelines formulation methods and processes of the Guidelines for the Diagnosis, Treatment, and Management of Iodine Refractory Differentiated Thyroid Cancer.

Objective To investigate the incidence and risk factors of intraoperative hypoxemia in non- cardiothoracic surgery under general anesthesia in high-altitude areas of Tibet, and briefly analyze the impact of intraoperative hypoxemia on the prognosis. Methods The clinical data of patients undergoing non-cardiothoracic surgery under general anesthesia in Tibet Autonomous Region People's Hospital from June 1, 2021 to August 31, 2022 were collected prospectively, including basic preoperative data, surgery information and anesthesia management. The main outcome was intraoperative hypoxemia. Multivariate Logistic regression was used to analyze the risk factors of intraoperative hypoxemia. The perioperative prognosis of patients with or without intraoperative hypoxemia was compared. Results A total of 161 patients having non-cardiothoracic surgery under general anesthesia who met the inclusion and exclusion criteria were included. Among them, 9 patients (5.6%) suffered intraoperative hypoxemia and 152 cases (94.4%) experienced non-intraoperative hypoxemia. Multivariate Logistic regression analysis showed that preoperative oxygen saturation ≤ 85%(OR=4.604, 95% CI: 1.064-19.916, P=0.041), preoperative hemoglobin ≥ 170 g/L (OR=5.396, 95% CI: 1.163-25.035, P=0.031), and preoperative pulmonary artery pressure ≥ 40 mm Hg (OR=11.744, 95% CI: 1.599-86.243, P=0.015) were independent risk factors for hypoxemia during non-cardiothoracic surgery under general anesthesia in people at high altitude in Tibet. The incidence of perioperative adverse cardiac events in patients with intraoperative hypoxemia was significantly higher than that in patients without intraoperative hypoxemia (55.6% vs. 15.1%, P=0.002). Conclusion Preoperative low oxygen saturation, hyperhemoglobin and pulmonary hypertension are the risk factors of intraoperative hypoxemia in non-cardiothoracic surgery under general anesthesia in people at high altitude in Tibet, and intraoperative hypoxemia may have a negative impact on the prognosis of patients.

Objective To construct a prognostic prediction model for chronic postsurgical pain after video-assisted thoracoscopic surgery and develop a risk evaluation tool. Methods As a single-center prospective study, the study enrolled 1 132 patients received video-assisted thoracoscopic surgery between November 2020 and May 2021 at Peking Union Medical College Hospital. Numeric rating scale was used to assess the severity of acute pain when they were discharged and chronic pain at 6 months after surgery. Patients were divided into two groups based on the presence or absence of chronic postsurgical pain. Multivariate Logistic regression was conducted to analyze the risk factors which were used to construct prediction model and draw nomogram for chronic postsurgical pain after video-assisted thoracoscopic surgery. Results 460 patients (40.6%) were reported chronic pain at 6 months after surgery. More women and more patients with coronary heart disease belonged to the group of chronic postsurgical pain. Patients reported higher scores of numeric rating scale when they were discharged and inclined to keep taking painkiller after discharge. However, there were fewer patients with incisions fewer than 3 or using nitrous oxide during surgery in the group of chronic postsurgical pain (P＜0.05). The outcome of multivariate Logistic regression showed that the history of coronary heart disease, not using nitrous oxide in surgery, incisions more than or equal to 3, and the score of numeric rating scale on discharge were independent risk factors for chronic postsurgical pain (P＜0.05). The area under the receiver operator characteristic curve of the prediction model was 0.734. Conclusions The prediction model is conducive to clinical management for chronic postsurgical pain after video-assisted thoracoscopic surgery.

Autoinflammatory diseases (AIDs) were defined over 20 years ago, and since then, 56 monogenic AIDs have been discovered. Due to the overlapping symptoms, AIDs are prone to misdiagnosis and mistreatment. Different AIDs are characterized by distinct genetic variants, and some AIDs have shown unique genetic characteristics in the Chinese population. Currently, there is no evidence-based guideline for the genetic diagnosis of AIDs in China. To further standardize the early recognition and precision diagnosis of AIDs, it is urgently needed to develop evidence-based clinical practice guidelines on the genetic diagnosis of AIDs to provide scientific guidance for the clinical management of AIDs. The Chinese Pharmacists Association Rare Diseases Medication Working Committee and the Subspecialty Group of Immunology from the Society of Pediatrics of the Chinese Medical Association have jointly launched a protocol for the development of the Guidelines for the Genetic Diagnosis of Autoinflammatory Diseases in China, which was registered and written following WHO Handbook for Guideline Development with the help of nationwide multidisciplinary experts organized by the Department of Pediatrics, Peking Union Medical College Hospital. A formal document of the guidelines will be devised and published following the workflow of evidence-based guideline development. This paper introduces the Guidelines for the Genetic Diagnosis of Autoinflammatory Diseases in China, including its background, significance, objectives, target population, guideline users, guideline working group members, and the workflow of guideline development.

Background/Objectives: Radial artery tracking (RAT) in the short-axis view is a pivotal step for ultrasound-guided radial artery catheterization (RAC), which is widely employed in various clinical settings. To eliminate disparities and lay the foundations for automated procedures, a pilot study was conducted to explore the feasibility of U-Net and its variants in automatic RAT. Methods: Approved by the institutional ethics committee, patients as potential RAC candidates were enrolled, and the radial arteries were continuously scanned by B-mode ultrasonography. All acquired videos were processed into standardized images, and randomly divided into training, validation, and test sets in an 8:1:1 ratio. Deep learning models, including U-Net and its variants, such as Attention U-Net, UNet++, Res-UNet, TransUNet, and UNeXt, were utilized for automatic RAT. The performance of the deep learning architectures was assessed using loss functions, dice similarity coefficient (DSC), and Jaccard similarity coefficient (JSC). Performance differences were analyzed using the Kruskal–Wallis test. Results: The independent datasets comprised 7233 images extracted from 178 videos of 135 patients (53.3% women; mean age: 41.6 years). Consistent convergence of loss functions between the training and validation sets was achieved for all models except Attention U-Net. Res-UNet emerged as the optimal architecture in terms of DSC and JSC (93.14% and 87.93%), indicating a significant improvement compared to U-Net (91.79% vs. 86.19%, p < 0.05) and Attention U-Net (91.20% vs. 85.02%, p < 0.05). Conclusions: This pilot study validates the feasibility of U-Net and its variants in automatic RAT, highlighting the predominant performance of Res-UNet among the evaluated architectures. [ABSTRACT FROM AUTHOR]