铁死亡是近年来发现的一种调节性细胞死亡，由细胞内微环境的氧化还原紊乱而启动，并受体内多种途径调控。研究表明，铁死亡在杀伤肿瘤细胞和抑制肿瘤生长中起着关键作用，还与器官损伤，特别是缺血再灌注损伤密切相关 [1,2,3,4]。靶向调控不同细胞铁死亡可能成为一种新的围术期麻醉管理思路，为抑制肿瘤细胞生长、降低肿瘤术后复发，或者减轻器官缺血再灌注损伤、减少围术期并发症提供新的研究方向和作用靶点。文本将对铁死亡的主要调控机制及铁死亡在抑制肿瘤生长和改善组织器官缺血再灌注损伤方面的研究进展进行综述。

Objective:To compare the effects of different anesthetic methods on the prognosis in the patients with stage Ⅲ breast cancer.Methods:Based on a multicenter randomized controlled trial (NCT00418457), 274 patients with untreated stage Ⅲ breast cancer, aged 18-85 yr, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, were enrolled in the study and assigned to thoracic paravertebral block (TPVB) combined with total intravenous anesthesia group (TPVB+ TIVA group, n=141) and general anesthesia group (GA group, n=133) by computer-generated randomization stratified by study site.The primary outcome parameter of this study was postoperative recurrence rate.The secondary outcome parameters were the degree of postoperative acute pain (assessed using visual analogue scale score), the incidence of postoperative nausea and vomiting (PONV), postoperative hospital stay time, and the incidence of persistent pain after breast cancer surgery (PPBCS) at 6 and 12 months after surgery (assessed using the modified Brief Pain Inventory). Results:Compared with group GA, no significant change was found in the postoperative recurrence rate ( HR=0.711, 95% confidence interval (CI) 0.418-1.210, P=0.209), the degree of postoperative acute pain and the incidence of PONV were decreased (mean difference ( MD) of visual analogue scale score -0.890, 95% CI -1.344--0.436, P<0.001; OR=0.236, 95% CI 0.083-0.674, P=0.007), and no significant change was found in postoperative hospital stay time and the incidence of PPBCS ( HR=1.000, 95% CI 0.778-1.286, P=1.000; OR=2.100, 95% CI 0.599-7.362, P=0.246) in group TPVB+ TIVA. Conclusion:Compared with general anesthesia alone, TPVB combined with total intravenous anesthesia can provide lower degree of postoperative acute pain and lower incidence of PONV, and exert no effects on postoperative recurrence, postoperative hospital stay time and PPBCS in patients with stage Ⅲ breast cancer.

Perioperative mortality has long been a concern. Although the intraoperative mortality rate has made a 10-fold reduction in the past 3 decades, the thirty-day postoperative mortality rate remains high. Patients die because signs of deterioration are missed. Deterioration of patients is often overlooked or not detected at all. One of the reasons is that the intensity of nursing and the frequency of monitoring vital signs are decreased from the Intensive Care Unit via wards to home. Early detection of physiological instability is crucial to prevent death and disability. Therefore, perioperative continuous monitoring of vital signs and other information is crucial to detect physiological instability and may have the potential benefit to reduce the perioperative mortality and the incidence of major postoperative complications. Wearable continuous vital-sign monitors are expected to achieve this vision. Nowadays this kind of device is available, but further research on it is still needed. This article reviewed the current status of vital-sign monitoring and the value of wearable vital-sign monitors during the perioperative period.