2020年 · 第100卷第47期

The novel coronavirus pneumonia (COVID-19 for short) pandemic has brought significant changes to residents' educational lives and daily work. However, there is no literature describing and assessing the impact of the pandemic on neurosurgery residents in the United States. The study investigated the impact of the COVID-19 pandemic on the workflow, burnout, and career satisfaction of neurosurgery residents in the United States. By e-mail, the researchers sent a survey assessing factors associated with career satisfaction and burnout to 1 374 American Association of Neurosurgeons (AANS) residents, along with binary and multivariate (logistic) regression analyses of predictors of burnout and career satisfaction. The survey received a total of 167 valid questionnaires with a response rate of 12.2%, similar to the response rate of similar studies. After excluding incomplete responses, a total of 111 valid questionnaires were obtained. The majority of respondents were male (65.8%) and Caucasian (75.7%). Residents reported reduced hours (67.6%) and concerns that COVID-19 would affect their completion of learning about neurosurgery (65.8%). Twenty-nine respondents (26.1%) had burnout and 82 respondents (73.9%) were satisfied with their careers. In multiple regression analysis, burnout and rotation/furlough changes (P=0.013) and the decision to no longer practise neurosurgery with the opportunity to choose (P<0.001) significantly correlated. The higher graduate seniority, the lower the degree of burnout (P=0.011）。 Residents showed higher career satisfaction when they focused their clinical work on neurosurgical care (P=0.065）。 Factors related to COVID-19 have contributed to changes in the workflow of neurosurgery residents in the United States.

SARS-CoV-2 infection has caused the novel coronavirus pneumonia (COVID-19) pandemic. Although there are many problems in the United States, such as a large number of patients infected with the epidemic and very tight medical resources, emergency neurosurgery still needs to be carried out normally during the epidemic. Based on the experience of epidemic prevention in many medical institutions in the United States, this study summarized the best practices of neurosurgery for neurosurgical emergency patients under the COVID-19 epidemic. The researchers gathered neurosurgeons from 13 different health systems across the United States, including those in outbreak areas, to explain their specific practices for neurosurgical emergency treatment of patients amid the COVID-19 pandemic. Patients experiencing neurosurgical emergencies should be treated as "respondents" (PUIs), and physicians should wear maximum personal protective equipment (PPE) during admission and patient transport. Manipulations such as intubation and extubation also require the anesthesiologist to perform the maximum PPE in a negative pressure environment. After the particulate matter in the air is removed, the relevant personnel can enter the operating room. Certain operating rooms should be designated as "COVID-19/PUI patient-only operating rooms" for the conduct of neurosurgical procedures for covid/PUI patients, which will require a post-processing procedure for terminal cleaning. Each dedicated operating room should be connected to a negative pressure chamber with a high-efficiency particulate filter so that PPE can be put on and off without contaminating the clean area.

In order to investigate whether critically ill and acute patients can access the medical services they urgently need, the study provides a summary description of the current situation of patients with neurological emergencies that emerged during the first phase of the novel coronavirus pneumonia (COVID-19) pandemic. In this observational longitudinal cohort study, all neurosurgical hospitalized patients admitted to the Berlin Neurosurgery and Stroke Research Center (CSB) of Charité Medical University Berlin, Germany during the COVID-19 pandemic from February 1 to April 15, 2020 were included, and were identified and classified according to the neurosurgical admission route, management mode and disease category. In addition, the researchers also investigated the clinical visits of patients with aneurysmal subarachnoid hemorrhage (ASAH) and chronic subdural hematoma (CSDH), respectively, to more fully understand the various symptoms caused by cerebrovascular events or acute trauma. During the pandemic, the proportion of neurosurgical emergencies among all neurosurgical hospitalizations was comparable to usual, but the proportion of visits via the emergency department was significantly higher than the proportion of visits via outpatient or referral (P=0.009）。 Among the various types of neurological disorders, the total number of patients admitted via the neuroemergency route is greatly reduced (P=0.000 7), not only vascular emergencies (P=0.036) was significantly reduced in the number of patients visited, and spinal spinal emergencies (P=0.007) and hydrocephalus (P=0.048) were also significantly reduced, among which patients with spinal emergencies were mostly admitted to hospital for treatment 48 h after the onset of symptoms (P=0.001）。 The number of cases of acute ASAH, ASAH grade, location of aneurysm rupture, and treatment modalities were not significantly changed from previous. Although elderly patients with chronic subdural hematoma present less frequently than in previous years, symptoms are more severe (P=0.046), the likelihood of a good prognosis at discharge (P=0.003) is lower.

Alzheimer's disease (AD) has great genetic complexity, and risk genes related to AD can be found through genome-wide association analysis (GWAS). Most of the previous reports are GWAS studies conducted in European and American countries, which are still blank in China. Moreover, genes found abroad are rarely verified in Chinese populations, and there is a lack of genetic prediction models that can predict the risk of AD. For this purpose, the study conducted a two-phase GWAS study with a total of 11,506 subjects from several research centers across the country. Whole genome genotyping of 4 187 subjects was performed in the first stage, and 34 loci of 7 319 subjects were genotyped in the second stage. Through two-stage consistency test and meta-analysis, it was found that 13 loci reached the GWAS significance boundary (P<5.0×10^-8), containing 4 new sites (rs3777215, rs6859823, rs234434, and rs2255835) and 9 points within the APOE region. In addition, it was found through the risk prediction model that the area under the curve predicted for AD can reach up to 0.73. This predictive model can carry out genetic screening for young people and give early warning to positive people, which has important clinical significance for preventing the occurrence of AD.

Maintaining normal liver function after radiofrequency ablation (RFA) for hepatocellular carcinoma is essential to improve prognosis. To investigate the effects of oral branched chain amino acids (BCAA) on liver function, intrahepatic recurrence rate and complication rate after RFA in patients with hepatocellular carcinoma, patients with cirrhosis who underwent RFA from August 2009 to April 2012 were randomly divided into oral branched chain amino acid group (BCAA group) and diet alone group (control group), and the changes of serological parameters and health status were observed. Patients in the BCAA group were given BCAA orally (1 pack twice daily). The Concise Quality of Life Scale-8 was used to assess the physical and psychological state of patients. Oral BCAA was started 2 weeks before RFA, and enhanced CT examination was performed every 3 months to assess the recurrence of liver cancer. The final number of cases enrolled in the study was 25 in the BCAA group and 26 in the control group, and the median follow-up time was 3.9 years (736 to 1 818 d). There was no statistically significant difference between the two groups at the baseline level. The results showed that the incidence of complications was lower in the BCAA group than in the control group (P=0.03）。 Event-free survival was significantly higher in the BCAA group than in the control group, while the intrahepatic recurrence rate was significantly lower than in the control group (Pvalues of 0.040 and 0.036, respectively). The Concise Quality of Life Scale-8 psychological score was significantly improved in the BCAA group (P<0.01）。