Hemodynamic monitoring and management of patients undergoing high-risk surgery:a survey among Chinese anesthesiologists

Hemodynamic monitoring and optimization improve postoperative outcome during high-risk surgery.However,hemodynamic management practices among Chinese anesthesiologists are largely unknown.This study sought to evaluate the current intraoperative hemodynamic management practices for high-risk surgery patients in China.From September 2010 to November 2011,we surveyed anesthesiologists working in the operating rooms of 265 hospitals representing 28 Chinese provinces.All questionnaires were distributed to department chairs of anesthesiology or practicing anesthesiologists.Once completed,the 29-item questionnaires were collected and analyzed.Two hundred and 10 questionnaires from 265 hospitals in China were collected.We found that 91.4%of anesthesiologists monitored invasive arterial pressure,82.9%monitored central venous pressure（CVP）,13.3%monitored cardiac output（CO）,10.5%monitored mixed venous saturation,and less than 2%monitored pulse pressure variation（PPV） or systolic pressure variation（SPV） during high-risk surgery.The majority（88%） of anesthesiologists relied on clinical experience as an indicator for volume expansion and more than 80%relied on blood pressure,CVP and urine output.Anesthesiologists in China do not own enough attention on hemodynamic parameters such as PPV,SPV and CO during fluid management in high-risk surgical patients.The lack of CO monitoring may be attributed largely to the limited access to technologies,the cost of the devices and the lack of education on how to use them.There is a need for improving access to these technologies as well as an opportunity to create guidelines and education for hemodynamic optimization in China.

Economic impact of land finance and subsequent risk response

In China,land finance is actually an endogenous factor in economic growth.As a kind of non-traditional,informal government revenue in China’s economic transition process,land finance is unstable,non-standard and unsustainable,and it simultaneously makes the current land-finance dependent growth mode difficult to maintain.The paper firstly analyzes the impact of the land finance on China’s economic growth and economic structure change followed by discussing the possible risks in post-“land finance”period.It then put forward some suggestions to deal with the problem.The analysis shows that land finance exacerbates the economic fluctuation,bringing in the increase of government public expenditure and economic growth in the short term.Nonetheless,in the long term there is no significant effect,and it could gradually lead to a more unreasonable economic structure.In the post-“land finance”period,if we do not take precautions in advance,it will restrain the sustainable development of China’s economy and society.

Evolution of drought and flood events on the Qinghai-Tibet Plateau and key issues for response

The Qinghai-Tibet Plateau is a climate-sensitive region.The characteristics of drought and flood events in this region are significantly different as compared to other areas in the country,which could potentially induce a series of water security,ecological and environmental problems.It is urgent that innovative theories and methods for estimation of drought and flood disasters as well as their adaptive regulations are required.Based on extensive literature review,this paper identifies new situations of the evolution of drought and flood events on the Qinghai-Tibet Plateau,and analyzes the research progress in terms of monitoring and simulation,forecasting and early warning,risk prevention and emergency response.The study found that there were problems such as insufficient integration of multi-source data,low accuracy of forecasting and early warning,unclear driving mechanisms of drought and flood disaster chains,and lack of targeted risk prevention and regulation measures.On this basis,future research priorities are proposed,and the possible research and development paths are elaborated,including the evolution law of drought and flood on the Qinghai-Tibet Plateau,the coincidence characteristics of drought and flood from the perspective of a water resources system,prediction and early warning of drought and flood coupled with numerical simulation and knowledge mining,identification of risk blocking points of drought and flood disaster chain and the adaptive regulations.Hopefully,the paper will provide technical support for preventing flood and drought disasters,water resources protection,ecological restoration and climate change adaptation on the Qinghai-Tibet Plateau.

The Profound Changes Unseen in a Century: The Perspective of Overlapping Effect of Technological Revolution Cycle and Political & Economic Thought Cycle

The waves of technological revolution can lead to great differences in the economic and social structures of countries and have a destructive impact. The choice of political and economic thoughts can amplify or inhibit such differentiation and impact. Over the past 100 years, humankind has undergone three technological revolutions, and the mainstream political and economic thoughts have experienced a cycle from classical liberalism to various types of anti-liberalism and finally to neoliberalism. In the two liberal periods, the overlap of liberalism and a technological revolution caused sharp contradictions between the rich and the poor, leading to profound economic adjustment and great political and social turmoil worldwide. In the non-liberal period, however, the overlapping effects were relatively mild. Currently, the world is facing similar trends and risks as during 1914-1940. Whether humankind will repeat the same mistakes merits attention and vigilance. This study argues that it is necessary to oppose unilateralism, uphold multilateralism, and advance globalization and free trade under the concept of collaborative development and shared prosperity, as well as explore comprehensive and sustainable development. These are of great significance for human society to prevent risks, obtain advantages and avoid disadvantages, and maintain world peace and development.