Purpose:Postoperative sore throat (POST) is one of the most common complaints after thoracic surgery with double-lumen endobronchial tubes (DLTs), significantly impacting postoperative recovery and patient satisfaction, yet it is often overlooked. Stellate ganglion block (SGB), a minimally invasive technique, may alleviate airway inflammation and modulate sympathetic tone. It has significant potential in reducing the incidence of POST, but evidence in DLTs patients is lacking. This trial aims to test whether preoperative ultrasound-guided SGB can ameliorate the incidence and severity of POST after thoracic surgery. Study Design and Methods:In this prospective double-blind, randomized controlled trial, 132 patients undergoing thoracoscopic resection of pulmonary lobes/segments with DLTs will be randomized to receive either US-guided SGB with 0.25% ropivacaine 4mL (Group S) or 0.9% saline 4mL (Group C) at the C6 level, on the same side as the thoracic surgery before anesthesia induction. The primary outcome is POST incidence at 6 hours postoperatively. The secondary outcomes include the incidence and severity of POST at 1, 24 and 48 hours, postoperative pain score (NRS) at different time points, postoperative nausea and vomiting, hoarseness, Quality of Recovery-15 scores, RCSQ sleep score, PCIA dosage at 24 and 48 hours. Intraoperative hemodynamic fluctuations, regional cerebral oxygen saturation (rSO2), anesthetic and vasoactive drugs will be recorded. All statistical analyses will be performed using SPSS version 26.0. Two-sided P values <0.05 will be considered statistically significant. Discussion:This is the first prospective trial evaluating ultrasound-guided SGB for POST after thoracic surgery with DLTs, also assessing the effect of SGB on postoperative recovery quality. The findings will provide more clinical evidence for perioperative SGB application to enhance early postoperative recovery and patient satisfaction.

Abstract Objectives To evaluate the impact of electroencephalogram-guided opioid-free anesthesia (OFA) on perioperative blood glucose variability in patients undergoing video-assisted thoracic surgery. Methods This article is a secondary analysis of a randomized controlled trial. Eligible patients were randomly allocated to either the OFA group or the opioid-based anesthesia (OBA) group. Patients in the OFA group did not receive any opioids during surgery, whereas those in the OBA group received sufentanil and remifentanil intraoperatively. The primary end point was the coefficient of variation for glucose (GLUcv), calculated based on predefined time points during the perioperative period. The secondary end points were the mean of glucose (GLUmean), the standard deviation of glucose (GLUSD), mean amplitude of glycemic excursions (MAGE), and largest amplitude of glycemic excursion (LAGE). Results A total of 126 patients were included in the final analysis: the OFA group (n = 64) and the OBA group (n = 62). Blood pressure, heart rate, sedation index, and analgesia index during surgery were comparable between the two groups, and there was no significant difference in pain in the early postoperative period. The primary end point, GLUCV, was significantly higher in OFA group than in OBA group (22.7 ± 9.1 vs 14.1 ± 6.0, P < 0.001). In addition, the OFA group had higher GLUmean (5.68 ± 0.87 vs 5.31 ± 0.87 mmol/L, P = 0.003), GLUSD (1.3 ± 0.59 vs 0.76 ± 0.40 mmol/L, P < 0.001), MAGE (1.75 ± 0.86 vs 0.95 ± 0.54 mmol/L, P < 0.001), and LAGE (2.97 ± 1.35 vs 1.72 ± 0.96 mmol/L, P < 0.001). Conclusion The OFA regimen provides sedation and analgesia comparable to OBA in video-assisted thoracic surgery, but is associated with greater perioperative blood glucose variation. Trial registration Clinicaltrials.gov, Identifier: NCT05411159. First posted date: 9 Jun, 2022. Date of enrolment of the first research participant: 10 Jun, 2022.

INTRODUCTION:Catheter-related bladder discomfort (CRBD) is a common and distressing complication after transurethral prostate surgery (TUPS). Many patients experience moderate to severe symptoms, which may delay recovery and reduce patient satisfaction. Currently, there are no standardised expert consensus statements or international guidelines for CRBD management. The ultrasound-guided anterior approach of sacral plexus block (anterior SPB) is a novel regional anaesthesia technique that may reduce CRBD through effects on multiple neural pathways. This trial is designed to evaluate the efficacy and safety of this technique in patients undergoing TUPS. METHODS AND ANALYSIS:This randomised, double-blind, placebo-controlled trial will enrol 90 male patients aged 50-80 years who are scheduled for elective TUPS under general anaesthesia. Participants will be randomly assigned (1:1) to receive either bilateral anterior SPB with 0.25% ropivacaine (20 mL per side) or saline placebo after anaesthesia induction. The primary outcome is the incidence of moderate-to-severe CRBD within 24 hours postoperatively. Secondary outcomes include the overall incidence and severity of CRBD, postoperative pain scores, rescue analgesia requirement, opioid consumption, emergence agitation, time to ambulation, quality of recovery, patient satisfaction and length of hospital stay. Safety outcomes include block-related, surgery-related and systemic adverse events. Data will be analysed using both modified intention-to-treat and per-protocol approaches. ETHICS AND DISSEMINATION:Ethical approval was obtained from the Ethics Committee of Beijing Chaoyang Hospital Affiliated to Capital Medical University on 25 April 2025 (2025-Ke-405-1). The results will be disseminated through peer-reviewed publications and presentations at academic conferences. TRIAL REGISTRATION NUMBER:ChiCTR2500102595.

Introduction:Effective analgesia after video-assisted thoracoscopic surgery (VATS) remains challenging, as conventional regional techniques mainly target somatic pain but insufficiently address visceral nociception transmitted via the vagus nerve. Cervical vagus nerve block (CVNB) is a novel ultrasound-guided regional technique that may attenuate vagally mediated visceral pain. However, high-quality randomized evidence on its analgesic efficacy and safety after VATS is lacking. This trial aims to evaluate whether adding CVNB to standard thoracic paravertebral block (TPVB) reduces postoperative opioid consumption in patients undergoing VATS lung resection. Methods and Analysis:This randomized, double-blind, placebo-controlled trial will enroll adult patients scheduled for elective VATS. Participants will be randomly assigned (1:1) to receive either 5 mL of 0.375% ropivacaine for CVNB (intervention group) or an equal volume of normal saline (placebo group), in addition to standardized TPVB. The primary outcome is cumulative opioid consumption within 24 hours postoperatively, expressed as intravenous morphine milligram equivalents (MME). Secondary outcomes include postoperative pain scores, time to first rescue analgesia, incidence of nausea and vomiting, quality of recovery, and sleep quality after surgery. A total of 110 patients are required to detect a clinically meaningful reduction in opioid consumption. Ethics and Dissemination:The study was approved by the Ethics Committee of Beijing Chaoyang Hospital (2025-ke-16) and has been registered on www.chictr.org.cn. Results will be disseminated through peer-reviewed journals and academic conferences. This study will be conducted in accordance with the principles of the Declaration of Helsinki. Trial Registration Number:Chinese Clinical Trial Registry: ChiCTR2500096880.

Perioperative neurocognitive disorders (PND), highly prevalent in geriatric surgical populations, constitute a major postoperative clinical challenge associated with prolonged hospital stays and adverse surgical outcomes. Although substantial research efforts have been devoted to investigating etiology, the precise molecular mechanisms of PND remains elusive, thereby hindering the development of effective therapeutic interventions. To address this gap, we conducted single-nucleus RNA sequencing on 119,109 hippocampal cells isolated from 18-month-old PND mice and age-matched controls, alongside performing complementary Western blotting and electrophysiological experiments. We propose that hippocampal neuronal excitation-inhibition (E/I) imbalance serves as a key mechanism underlying PND, which is associated with dysregulated inhibitory control of excitatory plasticity in PND pathology. Furthermore, we identified PND-associated astrocytes and oligodendrocytes—distinct from those in other cognitive disorders and linked to E/I imbalance. These cell types played distinct roles in the pathological process of PND. Our study proposes that E/I imbalance, associated with dysregulated inhibitory control of excitatory plasticity, underlies the pathogenesis of PND, providing new insights for therapeutic interventions.

Background Alzheimer's disease (AD) is a diverse and advancing neurodegenerative disorder that represents the prevalent type of cognitive decline. The objective of this research is to explore the possible impacts of genes related to 5-Methylcytosine (m5C) in Alzheimer's disease (AD). Methods By combining data from two Gene Expression Omnibus (GEO) datasets (GSE132903, GSE118553), the genes that were differentially expressed and associated with AD were extracted. Subsequently, m5C-related genes with differential expression (m5CRDEGs) were detected and their potential biological functions were assessed using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses. Association analysis and receiver operating characteristic curves (ROC) were used to analyze the m5CRDEGs.The expression and diagnostic efficiency of m5CRDEGs were validated in two external datasets (GSE33000, GSE122063). Moreover, the STRING database was utilized to construct a network of protein-protein interactions (PPIs), and Cytoscape was employed to visualize the hub genes. In the end, we analyzed the CIBERSORT algorithm to estimate the proportions of immune cell subsets. Results We identified five m5CRDEGs (ZBTB4, MBD4, ZBTB33, NEIL1, TDG) that were closely related to apoptosis, autophagy, circadian rhythm, acid metabolism, and p38MAPK pathway. The ROC curves demonstrated that ZBTB4 could function as a predictive hub gene for AD. In addition, our subsequent analysis of the miRNA/TF-mRNA networks showed that gene MBD4 had the most interaction with other m5CRDEGs based on five algorithms. Moreover, there was a significant association between hub gene expression and the abundance of CD8 + T cells and monocytes in our research. Conclusion New signatures from m5CRDEGs could potentially be used as biomarkers for AD, revealing a connection to the immune microenvironment that sheds light on the molecular mechanisms of AD and could support future research and treatment advancements.

Abstract Background Cancer patients face a markedly elevated risk of thromboembolism (TE), including both venous thromboembolism (VTE) and arterial thromboembolism (ATE), which contribute substantially to morbidity and mortality in this population. Objective This study examined sex disparities in associations between sleep, sedentary behavior (SB), light physical activity (LPA), moderate-to-vigorous physical activity (MVPA), and TE risk, in cancer patients using data from the UK Biobank. Methods A longitudinal cohort analysis of 6,765 cancer patients (2,774 men and 3,991 women) from the accelerometry subsample was conducted using Cox proportional hazards and isotemporal substitution models stratified by sex. Results The incidence of VTE was 3.0% in men versus 2.2% in women, while ATE incidence was 5.0% versus 2.2%, respectively. Compared with high LPA, medium and low durations were associated with 2.75- and 2.88-fold higher VTE risk only in men. Reallocating 1 h per day from sleep or SB to LPA reduced VTE risk by 24% and 19% in men. Low MVPA was associated with 3.35- and 1.59-fold higher ATE risk in women and men, respectively. Reallocating 1 h per day from sleep, SB, or LPA to MVPA reduced ATE risk by 71%, 70%, and 66%, respectively, only in women. Conclusions LPA was associated with a lower risk of VTE only in male cancer patients, whereas MVPA was linked to a lower risk of ATE in female patients, indicating sex-specific associations between movement behaviors and TE risk.

INTRODUCTION:Early cancer detection is crucial for improving outcomes. Ultrasound (US) imaging is widely accessible and cost-effective but limited by operator dependency and modest tissue contrast. Over the past decade, Artificial Intelligence (AI) has been increasingly utilized to enhance ultrasound-based cancer diagnosis, yet a comprehensive overview of this research landscape remains lacking. METHODS:We conducted a dual-database bibliometric analysis of literature from the Web of Science Core Collection and Scopus database covering 2015 to April 2025, using R software, VOSviewer, and CiteSpace. RESULTS:The field has grown rapidly since 2020, with 1,848 publications identified in the Web of Science dataset. China led in publication volume (n = 869) and showed the broadest international collaboration network, followed by the USA (n = 187), India (n = 113), Korea (n = 97), and Japan (n = 64). Frontiers in Oncology, Diagnostics, and Cancers were the most productive journals, while Radiology achieved the highest citation impact. Keyword co-occurrence and citation burst analyses revealed three major research hotspots. Firstly, designing deep learning-based computer-aided diagnosis models for automated cancer detection, segmentation, and classification. Secondly, embedding AI into clinical workflows to improve diagnostic accuracy and efficiency. Thirdly, developing multimodal fusion strategies to enhance diagnosis and guide prognosis and therapy. DISCUSSION:Integrating AI with US imaging shows strong potential to enhance cancer diagnosis. From algorithm refinement to clinical implementation and multimodal radiomics, AI-assisted US imaging may significantly impact cancer care. CONCLUSION:Future work should emphasize large, diverse datasets, multimodal integration, transparent algorithms, and prospective validation to ensure measurable patient benefits.

Retrograde intrarenal surgery (RIRS) is a minimally invasive treatment for upper urinary tract stones. However, anesthesia management in high-risk patients with significant comorbidities remains challenging, as general anesthesia poses elevated cardiopulmonary risks and spinal anesthesia is often contraindicated. This study aims to describe a novel regional anesthesia strategy combining ultrasound-guided quadratus lumborum block at the lateral supra-arcuate ligament (QLB-LSAL) with an anterior approach of sacral plexus block (SPB) as a potential alternative for RIRS in this vulnerable population. This prospective observational study enrolled 24 consecutive high-risk adult patients (ASA III–IV) scheduled for RIRS between February 2022 and May 2024. Patients received bilateral anterior approach SPB followed by unilateral QLB-LSAL. Data collected included the successful completion of surgery under regional anesthesia, conversion rates to general anesthesia, intraoperative pain scores (Numerical Rating Scale, NRS), supplemental analgesic requirements, hemodynamic stability, and block- or surgery-related adverse events. Postoperative pain scores, 30-day stone-free rate (SFR), and patient satisfaction were also assessed. All 24 patients successfully completed RIRS under the combined regional anesthesia without conversion to general anesthesia. Most patients (83.3

Background:Prognosis after liver transplantation for hepatocellular carcinoma (HCC) is driven mainly by tumor burden, vascular invasion, and alpha-fetoprotein. Routine pretransplant nutritional indices may add information on recipient condition, but direct comparisons are scarce and recurrence is not always analyzed with competing mortality. Methods:The development cohort included 254 adults undergoing first liver transplantation for pathologically confirmed HCC. Overall survival (OS) was the primary outcome; time to recurrence (TTR) was analyzed with death before recurrence as a competing event. Five nutritional indices were compared using Kaplan-Meier estimates, Cox regression, and restricted cubic splines. AGR underwent subgroup and Fine-Gray analyses. Conventional staging, AGR alone, a pretransplant clinical model, and the clinical model plus AGR were compared by discrimination, calibration, and decision curves. Time-dependent ROC curves included bootstrap 95% confidence intervals. Fixed development-model parameters were evaluated in an independent external validation cohort of 58 recipients. Results:Eighty-five patients died and 51 experienced recurrence. In the fully adjusted Cox model, each 1-standard-deviation (SD) increase in AGR was associated with lower overall mortality [hazard ratio (HR), 0.64; 95% confidence interval (CI), 0.48-0.84; P = 0.002]; GNRI was also associated with OS (HR, 0.75; 95% CI, 0.58-0.98; P = 0.037). The AGR-OS association was nonlinear (overall P < 0.001; nonlinear P = 0.004). The adjusted recurrence subdistribution HR was 0.66 per 1-SD increase in AGR (95% CI, 0.47-0.94; P = 0.022). Adding AGR increased the OS C-index from 0.750 to 0.780 in the development cohort and from 0.645 to 0.686 externally. At 3 years, the external AUC was 0.713 (95% CI, 0.574-0.834) for the clinical model and 0.764 (95% CI, 0.614-0.888) after AGR was added. Conclusions:AGR showed the most consistent associations with OS and recurrence among the five indices. Its addition produced modest improvements in the development cohort, with changes in the same direction during external validation. AGR may complement, but should not replace, established tumor-related prognostic factors.

STUDY OBJECTIVE:Chronic pain (CP) has been linked to multiple health complications, but its association with venous thromboembolism (VTE) remains unclear. We aimed to investigate the associations between CP and VTE risk, and the potential mediating role of 24-h movement behaviors. DESIGN:A prospective cohort study. SETTING:Population-based study using data from the UK Biobank. INTERVENTIONS:Not applicable; this was an observational study analyzing exposure to CP. MEASUREMENTS:CP was assessed as the main exposure, and incident VTE as the primary outcome. Exploratory analyses were conducted to examine the role of 24-h movement behaviors, including sedentary behavior (SB), light-intensity physical activity (LIPA), moderate-to-vigorous physical activity (MVPA), and sleep, in relation to CP and VTE. Multivariate-adjusted Cox proportional hazards regression, compositional mediation analysis, and isotemporal substitution Cox regression were applied to evaluate these associations. PARTICIPANTS:A total of 453,289 individuals were included in the analytic cohort, with 88,675 participants in the accelerometer sub-cohort for analyses of movement behaviors. MAIN RESULTS:Compared to the pain-free group, participants with limited chronic pain (LCP, HR: 1.13, 95% CI: 1.08-1.19, P < 0.001) and multisite chronic pain (MCP, HR: 1.32, 95% CI: 1.24-1.41, P < 0.001) showed increased VTE risk in the total cohort. In exploratory analyses within the accelerometer sub-cohort, 24-h movement behaviors showed a contribution to the MCP-VTE association (indirect effect HR = 1.03 [1.01-1.05]; total effect HR = 1.25 [1.02-1.48]; 12.8% mediated). Among MCP participants, hypothetical reallocation models suggested that reallocating one hour/day from sleep to LIPA (HR = 0.87, 95% CI: 0.76-0.99) or MVPA (HR = 0.59, 95% CI: 0.35-0.98) was associated with lower VTE risk. CONCLUSIONS:CP was associated with an increased risk of VTE. In participants with MCP, 24-h movement behaviors showed a potential association that may contribute to this relationship. However, these findings are exploratory and do not support causal or prescriptive interpretation.

INTRODUCTION:Recent evidence increasingly supports a potential role of Perivascular Macrophages (PVMs), a unique subpopulation of brain immune cells, in the pathogenesis of Alzheimer's disease (AD). Strategically positioned at the brain-vasculature interface, PVMs sense the redox status, modulate immunity, and potentially influence ferroptosis-an iron-dependent form of regulated cell death increasingly implicated in AD. However, whether the involvement of PVMs in AD pathology specifically entails mechanisms related to the crosstalk between immunometabolism and ferroptosis, and the precise molecular pathways linking PVMs, immunometabolism, and ferroptosis to AD, remains unclear. METHODS:We first obtained single-cell RNA sequencing data of PVMs from AD patients and control subjects via the GEO database, identified Differentially Expressed Genes (DEGs), and applied Mendelian Randomization (MR), with robustness validated via leave-one-out analysis to pinpoint key genes among the DEGs with causal relevance to AD. Next, we identified ferroptosis-related genes within these key genes and examined their associations with immune cell infiltration and immunometabolic signaling pathways, while also predicting their regulatory transcription factors to inform potential therapeutic strategies. RESULTS:We identified 149 DEGs in PVMs between AD and control groups, which were primarily enriched in immune and metabolic pathways. MR analysis established eight genes (ACSL1, SPATA6, RAB31, NIBAN1, HDAC4, GRAMD1B, GCC2, and DENND3) as causally and negatively associated with AD risk (IVW analysis identified all P < 0.05, with robustness confirmed by leave-one-out analysis), with ACSL1 being recognized as a known ferroptosis driver. Immune cell infiltration analysis revealed significant differences in monocyte and neutrophil proportions in AD, with DENND3 identified as the sole gene significantly correlated with monocyte abundance. The Key genes demonstrated distinct associations with immunometabolic pathways: GRAMD1B expression was positively associated with PI3K/AKT/mTOR signaling, whereas both NIBAN1 and SPATA6 showed enrichment in cells with high Notch signaling activity. ACSL1 exhibited robust associations with multiple pathways implicated in ferroptosis, including the IL-6/JAK/STAT3, interferon-γ, TGF-β, bile acid metabolism, and cholesterol homeostasis pathways, suggesting potential mechanisms that mediate the crosstalk between immunometabolism and ferroptosis. Transcription factor analysis highlighted shared regulation by CEBPD and the SP1/2/3/4 family, indicating convergent transcriptional control of these genes. CONCLUSION:This study identifies eight key genes in PVMs that may protect against AD through mechanisms involving the interplay between immunometabolism and ferroptosis. Our findings provide novel insights into the function of PVMs in AD pathophysiology and suggest potential therapeutic targets for this devastating neurodegenerative disease.

Introduction Remimazolam is a novel short-acting benzodiazepine that exhibits sedative and hypnotic properties without compromising respiratory function and while maintaining haemodynamic stability. Its safety and efficacy have been demonstrated to be non-inferior to those of propofol in the context of general anaesthesia. Nevertheless, the non-inferiority in terms of postoperative recovery quality in obese patients has not been established. Thus, we conducted a prospective, randomised, parallel-group, non-inferiority study to compare remimazolam-based general anaesthesia with propofol-based general anaesthesia on the postoperative quality of recovery (QoR) in patients undergoing laparoscopic sleeve gastrectomy.Methods and analysis All participants meeting the included criteria will be enrolled after signing an informed consent form. Patients will be randomly allocated to either the propofol group (n=63; induction and maintenance with propofol) or the remimazolam group (n=63; induction and maintenance with remimazolam). The primary endpoint of the study is the 15-item QoR Scale assessed at 24 hours postoperatively. Secondary endpoints include the doses of anaesthetic required for loss of consciousness (LOC), the time to LOC, the time to recovery of consciousness, the total amount of anaesthetic administered during the surgery and the incidence of hypotension and bradycardia. Additionally, postoperative profiles of pain, nausea and vomiting, delirium, intraoperative awareness, adverse events and patient satisfaction will be collected. Statistical analyses will be performed using IBM SPSS Statistics V.26.0 and GraphPad Prism V.5.01. Statistical significance is set at two-sided p values<0.05.Ethics and dissemination Ethical approval was obtained from the ethics committees of Beijing Chaoyang Hospital, Capital Medical University (No. 2023ke715-1). The findings will be disseminated in peer-reviewed publications.Trial registration number ChiCTR2400083700.

Purpose:Propofol and sufentanil are the most commonly used anesthetics during bronchoscopy. Esketamine is an s-enantiomer of ketamine racemate and has both sedative and analgesic effects, it does not inhibit respiration and maintains hemodynamic stability. We aimed to compare the intraoperative hypoxemia risk of esketamine/propofol with sufentanil/propofol for patients in bronchoscopy. Methods:This study was an investigator-initiated, single-center, randomized, double-blind clinical trial. Patients undergoing bronchoscopy were randomly assigned to receive either sufentanil group (n = 33; sufentanil: 0.2 μg/kg) or esketamine group (n = 33; esketamine: 0.2 mg/kg) for sedation and analgesia. Clinical data, anesthetics usage, incidence of intraoperative hypoxemia, total time of hypoxemia, recovery time, and adverse events were recorded. Main Results:The incidence of intraoperative hypoxemia was significantly lower in the esketamine group than in the sufentanil group (27.2% vs 66.7%, P=0.001, OR=5.333, 95% CI=1.859-15.301). Propofol usage was significantly higher in the esketamine group than in the sufentanil group (t=2.952, P=0.004). The duration of hypoxia was significantly lower in the esketamine group than in the sufentanil group (Z=-3.445, P<0.001), and the minimum oxygen saturation (SpO2) was significantly higher than in the sufentanil group (Z=-2.682, P=0.007). Recovery time from anesthesia was significantly lower in the esketamine group than in the sufentanil group (Z=-2.709, P=0.007). No difference was found in adverse reactions between the two groups. Conclusion:Esketamine combined with propofol reduced the incidence of intraoperative hypoxemia compared with sufentanil in bronchoscopy. Our results offer the possibility for a novel recommendation for the prevention of intraoperative hypoxemia during bronchoscopy. However, we mentioned the higher propofol use in the esketamine group. Additional clarification is necessary on the indications and the optimal dose of esketamine. Trial Registration:Chinese clinical trial registry: ChiCTR2200058990.

Postoperative nausea and vomiting (PONV) is common after video-assisted thoracic surgery, which may be associated with the use of intraoperative opioids. We tested the hypothesis that balanced opioid-free anesthesia (OFA) might reduce the incidence of PONV after video-assisted thoracic surgery. One hundred and sixty-eight adults undergoing video-assisted thoracic assisted surgery were randomly assigned to receive balanced opioid-free anesthesia or balanced opioid-based anesthesia (OBA). The primary outcome was the incidence of PONV, which was assessed with the Myles’s simplified PONV impact scale during the initial 24 h after surgery. Compared with OBA group, the overall incidence of PONV in OFA group was significant reduced (14.6

Background and Objectives: Growing evidence suggested that abnormal lipid metabolism (ALM) was associated with an increased severity of depressive symptoms, but no previous studies have examined the differences in comorbid ALM in major depressive disorder (MDD) patients of different ages of onset. We aim to compare the differences in the prevalence and clinical correlates of ALM between early-onset and late-onset patients with first-episode and drug-naive (FEDN) MDD patients. Methods: Using a cross-sectional design, we recruited a total of 1718 FEDN MDD outpatients in this study. We used the 17-item Hamilton Rating Scale for Depression (HAMD-17), The Hamilton Anxiety Rating Scale (HAMA), the Positive and Negative Syndrome Scale (PANSS) positive subscale, and Clinical Global Impression-Severity Scale (CGI-S) to assess their depression, anxiety, and psychotic symptoms and clinical severity, respectively. Results: There were 349 patients (20.3%) in the early-onset subgroup and 1369 (79.7%) in the late-onset subgroup. In this study, 65.1% (1188/1718) of patients were diagnosed with ALM. The prevalence of ALM in the late-onset group (81.5%, 1116/1369) was significantly higher than that in the early-onset group (20.6%, 72/349) (p = 0.36, OR = 1.147, 95%CI = 0.855–1.537). The HAMD total score (OR = 1.34, 95% CI = 1.18–1.53, p < 0.001) was the only risk factor for ALM in early-onset MDD patients. In late-onset MDD patients, the HAMD total score (OR = 1.19, 95% CI = 1.11–1.28, p < 0.001), TSH (OR = 1.25, 95% CI = 1.16–1.36, p < 0.001), CGI (OR = 1.7, 95% CI = 1.31–2.19, p < 0.001), and anxiety (OR = 2.22, 95% CI = 1.23–4.02, p = 0.008) were risk factors for ALM. Conclusion and Scientific Significance: Our results suggest that there are significant differences in the prevalence and clinical factors of comorbid ALM between early-onset and late-onset FEND MDD patients.

Perioperative neurocognitive disorders (PND) is one of the most common postoperative complications among elderly patients (above 65 years old) undergoing cardiac surgery. However, thus far, there have not been any effective therapies for managing PND. Recent research has shown that repetitive transcranial magnetic stimulation (rTMS) alters brain plasticity and improves cognitive function in several neurodegenerative disorders and psychiatric disorders. However, the potential benefits of rTMS in reducing PND in patients undergoing cardiac surgery have not been investigated. Therefore, the current protocol is designed to determine whether rTMS can reduce the incidence of PND in patients undergoing cardiac surgery. The study will be a single-blinded, randomized controlled trial. Participants undergoing elective cardiac surgery will be randomized to receive either rTMS or sham stimulation with focal figure-of-eight coils over the right dorsolateral prefrontal cortex. A series of neuropsychological tests will be completed to evaluate cognitive function in surgery patients before, on day 7, and on day 30 after cardiac surgery. The primary outcome is the prevalence of PND in cardiac surgery patients. The secondary outcomes will be the incidence of postoperative delirium, pain, sleep quality, depressive symptoms, activities of daily living, length of hospital stay and ICU length of stay, and rate of complication and mortality during the hospital stay. Beijing Chaoyang Hospital Ethics Committee approved this study and has the number 2022-ke-487. It is registered with Clinical Trials (trial number NCT 05668559). Informed consent must be provided by all participants. The study result will be published in a peer-reviewed journal. NCT05668559. Registered on June 6, 2022.

Curcumin has antifragmentation, antivirus, anti‐infection, and antioxidation properties. Curcumin has been proven to prevent the peroxidation of sperm and testis membranes, thus enhancing sperm motility and reducing sperm abnormalities. This study aims to explore the role of curcumin in improving hydrocortisone (HCT)‐induced Leydig cell injury by upregulating the Nrf2 pathway. Thirty male rats were divided into three groups: control group (CG, n = 10), model group (MG, n = 10), and curcumin treatment group (CTG, n = 10). CG rats were fed 2.5 mL/kg carboxymethyl cellulose as a blank control. MG rats were fed with 10 mg/kg HCT for 2 weeks. CTG rats were fed with 10 mg/kg HCT for 2 weeks and 100 mg/kg curcumin orally every day for 4 consecutive weeks. The ultrastructural score of Leydig cells was higher in the MG than in the CG (p < 0.05) and was lower in the CTG than in the MG (p < 0.05). The levels of Nrf2 and HO‐1 were lower in the MG than in the CG (p < 0.05) and higher in the CTG than in the MG (p < 0.05). Curcumin can improve the biochemical and histological structural damage of rat testes induced by HCT by upregulating Nrf2 expression. This protective effect relies on the Nrf2 pathway inhibiting oxidative stress in the body, increasing testosterone levels and enzyme activity, thereby improving testicular dysfunction caused by interstitial cell damage.

Background This study aimed to investigate the relationship between cognitive performance and relative fat mass (RFM) in older American males.Methods For the purpose of this cross-sectional research, a total of 1,321 individuals were selected from the National Health and Nutrition Examination Survey (NHANES), which was carried out between the years 2011 and 2014. Specifically, the Consortium to Establish a Registry for Alzheimer’s Disease Word Learning Test (CERAD-WL), the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST) were used in order to achieve the objective of assessing cognitive function. Z-scores were calculated as a composite, generalized metric by taking the average of the standardized scores of the three previously mentioned assessments. RFM was ascertained by measuring waist circumference (WC) and height. Multivariate linear regression, threshold effect analyses, smooth curve fitting, and subgroup analyses were undertaken in order to investigate the connections that exist between RFM and cognitive function.Results The study included 1,321 male volunteers who were at least 60 years old, and complete data was provided for each individual. Fully adjusted models indicated a negative correlation between RFM and CERAD-WL scores[-0.17, (-0.32,-0.01)], DSST scores[-0.83, (-1.16,-0.50)] and Z-scores[-0.03, (-0.05, -0.01)]. It was observed that the negative correlation between RFM and Z-scores became more pronounced when RFM exceeded 35.78. Furthermore, subgroup analyses showed that the association between RFM and cognitive function was significantly impacted by education level, poverty-income ratio (PIR), smoking status, and drinking status.Conclusions In elderly men, a higher RFM was linked to lower cognitive function, suggesting that management of RFM may prove advantageous in mitigating cognitive decline among older male populations.