BackgroundS-ketamine, a widely used clinical analgesic drug and also employed as a therapeutic regimen in cancer pain management, but whether S-ketamine influence on effector immune cells when conquering tumor cells remains unclear.MethodsIn this study, we established effector T cells (chimeric antigen receptor T cells (CAR- T cells) and TCR-engineered T cells (TCR-T cells)) and treated with different concentrations of S-ketamine and investigated its impact on antitumor efficacy of effective T cell in vitro and in vivo assays.ResultsOur findings demonstrated that S-ketamine treatment induced apoptosis in CAR- T and TCR-T cells, with higher concentrations leading to significant cell death. Furthermore, during coculture with target cells, increasing S-ketamine concentrations progressively dampened the early and late activation, impaired the tumor-killing capacity of both CAR-T and TCR-T cells, accompanied by reduced secretion of effector cytokines— particularly a striking downregulation of TNF-α production. Meanwhile, the expression of immune checkpoint receptors in T cells was upregulation under target cell stimulation and S- ketamine treatment. Consistent with in vitro findings, escalating S- ketamine concentrations dampened the tumor inhibition of TCR-T cells in a xenograft tumor model, and also diminished the tumor-infiltrating capability of TCR-T cells.Conclusionsour study reveals that S- ketamine suppresses the cytotoxic function and promotes exhaustive phenotype of effector T cells when conquering the target cells, and providing some new guides in clinical use of S-ketamine on cancer pain therapy

OBJECTIVES:This study aimed to compare the incidence of hypotension between remimazolam and propofol in hypertensive patients undergoing spinal surgery. METHODS:We conducted a retrospective analysis of 194 hypertensive patients who received either remimazolam (n=99) or propofol (n=95) as the primary anesthetic during spinal surgery under general anesthesia. Hemodynamic parameters and bispectral index (BIS) were continuously monitored. The primary outcome was the incidence of intraoperative hypotension, defined as a mean arterial pressure (MAP) below 80% of baseline within 13 minutes of drug administration. Severe hypotension was defined as MAP below 70% of baseline. Postoperative adverse events, including postoperative nausea and vomiting (PONV), injection pain, dizziness, delirium, and hypoxemia, were also recorded. RESULTS:The incidence of hypotension was significantly lower in the remimazolam group compared to the propofol group (82.83% vs. 93.68%, P=0.019). The remimazolam group demonstrated more stable MAP at key time points (5-12 minutes post-induction) and a lower incidence of PONV (15.15% vs. 29.47%, P=0.016) and injection pain (2.02% vs. 26.32%, P<0.001). Multivariate logistic regression identified remimazolam as an independent protective factor against hypotension (odds ratio [OR] =0.435, 95% confidence interval [CI]: 0.210-0.901, P=0.025). CONCLUSIONS:For hypertensive patients undergoing spinal surgery, remimazolam is associated with a significantly lower risk of intraoperative hypotension and fewer adverse events compared to propofol, suggesting it may be a safer anesthetic option for this population.

Background: Dexmedetomidine, in combination with opioids, improves postoperative analgesia and sleep quality. Some previous trials also report reduced delirium, although others do not. We therefore tested the primary hypothesis that dexmedetomidine supplemented analgesia reduces delirium in older patients during the initial 5 days after major cancer surgery. Methods: We enrolled patients 65-90 years old who were scheduled for major cancer surgery expected to last ≥2 hours with general anesthesia. All were given patient-controlled morphine (0·5 mg/ml) analgesia after surgery, supplemented with either dexmedetomidine (1·25 μg/ml) or placebo which was randomly assigned and fully blinded. Our primary endpoint was the incidence of delirium which was assessed twice daily during the initial 5 postoperative days. Pain intensity and subjective sleep quality were assessed with 11-point scales with 10 being worst. Results: A total of 1500 patients (mean age 72 years; 492 [33%] women) were enrolled and randomized; all were included in the intent-to-treat analysis. Patients in the dexmedetomidine group had a median infusion rate of 0·021 μg/kg/h (interquartile range, 0·018 to 0·025). Delirium occurred in 10·4% (78/750) of patients with dexmedetomidine vs. 15·7% (118/750) of patients with placebo (relative risk, 0·66; 95% CI, 0·51 to 0·86; P=0·002). Dexmedetomidine reduced the proportion of patients with moderate-to-severe pain with movement (relative risk, 0·90; 95% CI, 0·84 to 0·97; P=0·004) within 5 postoperative days. The fraction of patients who reported moderate-to-severe sleep disturbances within 5 days was also lower in patients assigned to dexmedetomidine (relative risk, 0·94; 95% CI, 0·89 to 1·00; P=0·035). Adverse events were comparable in each group. Conclusions: In older patients after major cancer surgery, dexmedetomidine-supplemented opioid analgesia reduced delirium by a third without provoking complications. Low-dose dexmedetomidine should be considered as an adjuvant to opioid analgesia for prevention of postoperative delirium.

OBJECTIVES:Intraoperative neurophysiological monitoring (IONM) plays a critical role in spinal surgery by reducing the risk of nerve injury; however, its quality can be significantly influenced by anesthetic agents. This study aimed to compare the effects of remimazolam and propofol on IONM performance and postoperative recovery. METHODS:This retrospective analysis included patients who underwent prone-position spinal surgery with IONM between January 2021 and June 2025. Patients were divided into either a remimazolam group or a propofol group according to the primary sedative administered. The outcomes assessed included IONM parameters [somatosensory evoked potentials (SEP)/motor evoked potentials (MEP) amplitude/latency] after intubation (T1) and at 30 min (T3) and 50 min (T4) following recovery from neuromuscular blockade. Additional outcomes included hemodynamics, remifentanil consumption, recovery time, and cognitive function scores. RESULTS:A total of 204 patients included in the analysis (Remimazolam group: 101 cases, Propofol group: 103 cases). Compared to the propofol group, the remimazolam group demonstrated significantly improved IONM signals, higher SEP amplitude at T4 (2.16 vs. 1.97 μV, P<0.001), and higher MEP amplitude at T4 (1680.73 vs. 1500.64 μV, P<0.001). The incidence of hypotension (6.93% vs. 19.42%, P=0.009) and bradycardia (5.94% vs. 14.56%, P=0.043) were significantly lower, while remifentanil consumption was significantly higher (2005.64 vs. 1425.44 ug, P<0.001) in the remimazolam group. In addition, patients in the remimazolam group exhibited shorter recovery times (awakening time: 18.91 vs. 24.25 min, P<0.001) and better cognitive function (MoCA score on postoperative Day 3: 24.41 vs. 23.54, P<0.001). CONCLUSIONS:Remimazolam provides superior IONM conditions, a lower incidence of intraoperative hypotension and bradycardia, and faster postoperative recovery compared to propofol in patients undergoing spinal surgery.

Intrapartum cesarean section (CS) after epidural labour analgesia (ELA) is usually managed by catheter top-up, yet some centres prefer repeat spinal anaesthesia (SA) for speed and density of block. The failure rate of this strategy and its dose–response relationship with prior epidural drug exposure remain uncertain. This retrospective cohort study aimed to determine the incidence and risk factors of failed repeat SA in parturients undergoing intrapartum CS after receiving ELA. We reviewed all parturients who received ELA and subsequently underwent intrapartum CS at Peking University International Hospital (Jan 2024–May 2025). Among 167 eligible women, 102 received repeat SA while 64 received epidural top-up, one received general anaesthesia (GA). The primary outcome was failed repeat SA, defined as inadequate surgical block before skin incision requiring re-puncture, epidural rescue or conversion to GA. Multivariable logistic regression was used to identify independent risk factors of failed repeat SA. Eighteen of 102 repeat SA cases failed (17.6

BACKGROUND:Disorders of consciousness (DoC) present significant therapeutic challenges with limited effective interventions. The choice of anesthetic agent during procedures such as spinal cord stimulation may influence long-term neurological outcomes, yet comparative evidence is scarce. This prospective, non-randomized, comparative effectiveness trial investigated the neurophysiological and clinical effects of esketamine versus propofol in patients with DoC. METHODS:In this prospective, non-randomized trial, 34 adult DoC patients undergoing spinal cord stimulator implantation were allocated to receive either esketamine (n = 17) or propofol (n = 17) as the primary anesthetic, based on clinical practice. Multimodal assessments included the Coma Recovery Scale-Revised (CRS-R) at baseline and 3-month follow-up, along with high-density electroencephalography (EEG) to analyze permutation entropy (PE) and weighted phase lag index (wPLI). Multivariable regression adjusted for key confounders. RESULTS:Compared to propofol, esketamine was associated with significantly faster recovery of spontaneous respiration (12.02 ± 3.88 vs. 17.42 ± 4.62 min, p = 0.005) and reduced need for intraoperative vasopressors (17.65% vs. 52.94%, p = 0.034). EEG analysis revealed that esketamine better preserved brain electrical complexity (higher permutation entropy during maintenance, p < 0.001) and maintained higher functional connectivity, particularly in the gamma band (weighted phase lag index, p = 0.054). CONCLUSION:Esketamine demonstrates superior neurophysiological preservation over propofol in patients with disorders of consciousness, maintaining neural complexity and gamma-band connectivity during anesthesia. These mechanisms are associated with accelerated respiratory recovery, hemodynamic stability, and significantly improved consciousness outcomes at 3 months, supporting its potential as a neuroprotective anesthetic in this population.

Background:Preoperative fasting is a cornerstone of Enhanced Recovery After Surgery (ERAS) protocols in cesarean delivery, primarily aimed at reducing aspiration risk. However, its impact on acute postoperative pain remains unclear. This study addresses a critical evidence gap regarding whether adherence to ERAS-compliant fasting guidelines influences post-cesarean pain intensity. Methods:Data from 329 women who underwent cesarean sections at the hospital between March and December 2024 were retrospectively reviewed. Women were categorized based on adherence to ERAS fasting guidelines (≤8 h solids, ≤2 h clear fluids). The primary outcome was the 24-h postoperative Visual Analogue Scale (VAS) pain score. Univariate and multivariable linear regression models were used to assess the association between fasting compliance and VAS scores, adjusting for key covariates including age, body mass index, comorbidities, anesthesia type, surgical duration, and intraoperative morphine use. Results:Women adhering to ERAS fasting protocols had significantly lower mean 24-h VAS scores compared to non-adherent women (β = -0.6; 95% confidence interval: -1.2, -0.1; P = 0.029). This association remained significant after minor (β = -0.6; P = 0.046) and partial adjustment (β = -0.6; P = 0.038), though it attenuated to non-significance after full adjustment including epidural morphine (β = -0.5; P = 0.137). Subgroup analyses suggested consistent directional effects, but detailed subgroup results are reported in the main text. Conclusions:Adherence to ERAS fasting guidelines is associated with a modest but statistically significant reduction in acute postoperative pain after cesarean section. While the clinical relevance of a 0.6-point VAS difference may be limited, these findings support integrating standardized preoperative fasting into obstetric ERAS pathways as a safe, low-cost component of multimodal pain management and enhanced recovery.

AIM:Gynecological malignancies are common cancers in women, with postoperative liver and kidney function impairment significantly impacting long-term prognosis. Therefore, this study aimed to evaluate the effects of anesthesia and surgical interventions on postoperative liver and kidney function in patients with gynecological malignancies and explore its association with long-term survival outcomes. METHODS:This single-center retrospective cohort study included 153 patients who underwent surgery for ovarian cancer (50 cases), endometrial cancer (63 cases), and cervical cancer (40 cases) at Peking University International Hospital between 2018 and 2023. Demographic data, anesthesia methods (general or regional), surgical approaches (laparoscopic or open), and perioperative hepatorenal function indicators (Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Total Bilirubin (TBIL), creatinine and urea) were analyzed. Multivariate regression analysis adjusted for potential confounders, and survival models assessed long-term patient outcomes. RESULTS:Analysis of variance (ANOVA) revealed significant differences among the three cohorts in postoperative levels of ALT (p = 0.044), AST (p < 0.001), TBIL (p < 0.001), creatinine (p = 0.026), and urea (p < 0.001). Within each cohort, significant postoperative elevations were observed for ALT, AST, TBIL, creatinine, and urea compared to preoperative levels (all p < 0.05). Intergroup comparisons revealed that cervical cancer patients exhibited the most severe biochemical disturbances (95% stage IV, p < 0.001), with significant postoperative decreases in red blood cell (RBC) count (p < 0.001), hemoglobin (Hb) levels (p < 0.001), and platelet count (p = 0.003), alongside a substantial increase in white blood cell (WBC) count (p < 0.001). Multivariate linear regression analysis revealed that advanced tumor stage (Stage IV vs. I) was independently associated with elevated postoperative ALT (p = 0.001), AST (p < 0.001), TBIL (p < 0.001), and urea (p = 0.002) levels; however, its association with creatinine levels did not reach statistical significance (p > 0.05). Further analysis demonstrated that open surgery (vs. laparoscopic) significantly predicted increased creatinine (p = 0.002) and urea (p = 0.015) levels and TBIL (p = 0.002), whereas no significant effects were observed on ALT or AST (p > 0.05). Moreover, prolonged operative time (per 10 minutes) independently contributed to elevated AST (p = 0.015), TBIL (p = 0.018), and urea levels (p < 0.001). Similarly, intraoperative blood loss (per 100 mL) was associated with higher AST (p = 0.002), TBIL (p = 0.003), and urea levels (p = 0.003), while its associations with ALT (p = 0.083) and creatinine (p = 0.089) were not significant. Notably, pathological grade (G3 vs. G1), mode of anesthesia (general vs. local anesthesia), and age were not significantly associated with these biomarkers (p > 0.05). Furthermore, survival analysis revealed significantly reduced 5-year survival in patients with hepatorenal dysfunction, with survival curves diverging markedly from 32 months post-surgery (p < 0.001). CONCLUSIONS:Perioperative hepatorenal injury in gynecological malignancies is independently associated with tumor stage, open surgery, prolonged operative time, intraoperative blood loss, and tumor biology, and it critically impacts long-term survival. Therefore, minimally invasive techniques and optimizing perioperative management are essential to reduce organ damage and improve patient outcomes.

ObjectiveLe Fort III osteotomy and advancement in children with Crouzon syndrome represents a crucial therapeutic modality for severe midface hypoplasia. These procedures are highly invasive and associated with significant intraoperative hemorrhage and difficult airway management, posing substantial anesthetic risks. This study aims to summarize perioperative anesthetic management strategies, describe perioperative outcomes, and analyze risk factors for postoperative complications in this specific population.MethodsMedical records of consecutive children with Crouzon syndrome undergoing Le Fort III osteotomy and advancement were retrospectively reviewed from Peking University International Hospital between December 2017 and January 2026. Inclusion criteria were: (i) diagnosis of Crouzon syndrome; (ii) underwent Le Fort III osteotomy and advancement; and (iii) age younger than 18 years at the time of surgery. Data extracted included demographics, perioperative management, complications, fluid and transfusion volumes, and length of stay. Risk factors for postoperative complications were analyzed using univariate and multivariate logistic regression.ResultsA total of 47 children (male, 24) were enrolled, with a median age of 6 years (IQR, 6–10 years). The median operative time was 215 minutes (IQR, 180–279 minutes), intraoperative blood loss was 14.3 mL/kg, and the allogeneic blood transfusion rate was 68.1%. Postoperative complications occurred in 29.8% of patients (14/47). Multivariate logistic regression analysis identified operative duration (odds ratio [OR] = 1.010; 95% confidence interval [CI], 1.001–1.021; P = 0.048) as an independent risk factor for postoperative complications. Intraoperative fresh frozen plasma transfusion were not significant in the adjusted model.ConclusionAnesthetic management for Le Fort III osteotomy in children with Crouzon syndrome requires meticulous attention to difficult airway anatomy and significant intraoperative hemorrhage. Prolonged operative duration significantly increase the risk of postoperative complications. Future research should prioritize multicenter prospective cohort designs to establish larger, more comprehensive databases capable of validating the present findings.

Introduction Postoperative acute pain following video-assisted thoracoscopic surgery (VATS) impedes patient rehabilitation. While multimodal analgesia effectively mitigates postoperative acute pain and facilitates the postoperative rehabilitation process, the efficacy of preventive precision multimodal analgesia (PPMA) remains uncertain. This study designs a PPMA strategy targeting incisional pain, inflammatory pain and visceral pain in VATS. It aims to investigate the impact of the PPMA strategy on the postoperative acute pain process and rehabilitation outcomes.Method and analysis This multicentre, single-blinded, randomised controlled trial will enrol adult patients scheduled for elective thoracoscopic lobectomy or segmentectomy. A total of 1372 participants will be recruited and randomly allocated in a 1:1 ratio to either the preventive precision multimodal analgesia group (PPMA Group) or the conventional multimodal analgesia group (CMA Group). Patients in the PPMA Group will receive a regimen consisting of local anaesthetic infiltration of surgical incision (for incisional pain), intravenous injection of oxycodone (for visceral pain) and parecoxib sodium (for inflammatory pain) before surgery initiation. Patients in the CMA Group will receive the same regimen after specimen isolation. This trial will be conducted across 13 medical centres in China from 2023 to 2026. The primary outcome is the duration of postoperative acute pain. Secondary outcomes include postoperative analgesic consumption, postoperative pain scores, intraoperative haemodynamic parameters and the Indexes of Consciousness (IoC1 and IoC2), as well as intraoperative arterial blood gas and ventilation parameters, intraoperative dosages of general anaesthesia, inflammatory markers at predefined time points, postoperative rehabilitation process and perioperative adverse events and complications.Ethics and dissemination This study has been approved by the Ethics Committee of Xuanwu Hospital, Capital Medical University (Linyanshen[2023]-NO.012-003-Revised Vision 1). The results will be published in a peer-reviewed journal.Trial registration number Chinese Clinical Trial Registry (ChiCTR2300072176).

Background: Resting-state functional magnetic resonance imaging provides insight into brain function in patients with consciousness disorders. We investigated the variability in functional brain networks in consciousness disorders with different etiologies and identified potential correlations with recovery. Methods: In this single-center prospective observational study, we included seven patients with traumatic brain injury, seven with cerebrovascular accidents, and a healthy control group of eight participants with intraspinal space-occupying lesions. All participants underwent resting-state functional magnetic resonance imaging and were assessed using the Coma Recovery Scale-Revised. Regional homogeneity values were compared across groups to evaluate differences in functional brain activity. Results: Patients with traumatic brain injury demonstrated increased regional homogeneity values in the right fusiform gyrus, left middle cingulum, and right inferior frontal gyrus and reduced values in the left middle temporal gyrus, right supramarginal gyrus, right supplementary motor area, right precentral gyrus, and inferior frontal gyrus. Both groups exhibited higher regional homogeneity values in subcortical nuclei compared with the healthy control group. Patients with traumatic brain injury had reduced regional homogeneity in the paracentral lobule and frontal, temporal, and supramarginal regions compared with patients with cerebrovascular accidents. Preoperative Coma Recovery Scale-Revised scores were positively correlated with regional homogeneity in the hippocampus and negatively correlated with regional homogeneity in the midline temporal region. For 3 months, both groups showed improved consciousness. Conclusions: Regional homogeneity analysis can identify alterations in functional brain activity associated with recovery of consciousness, offering potential neuroimaging biomarkers for clinical assessment and prognosis for consciousness disorders. (c) 2025 Published by Elsevier Ltd on behalf of Tsinghua University Press. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

AIM:This study aimed to investigate the effect of intravenous anesthesia with remimazolam besylate on hemodynamics and neuroprotection in patients undergoing surgery for craniocerebral injury. METHODS:This retrospective study analyzed the clinical data from 92 patients with craniocerebral injury who underwent craniotomy at Peking University International Hospital between May 2021 and August 2023. Based on anesthesia method applied, patients were divided into the observation group (n = 49) and the conventional group (n = 43). The conventional group underwent conventional anesthesia, and the observation group received intravenous anesthesia with remimazolam besylate. All patients were followed up for 3 months after surgery. Furthermore, perioperative hemodynamic indicators and neurological function were compared between the two groups at different time points, such as T0 (before surgery), T1 (30 minutes after anesthesia), T2 (at the end of surgery), and T3 (24 hours post-surgery). Additionally, perioperative indicators, postoperative adverse reactions, and prognosis were statistically analyzed. RESULTS:From T0 to T1, heart rate (HR), peripheral capillary oxygen saturation (SpO2), and mean arterial pressure (MAP) showed an increasing trend in both groups. Afterwards, HR and MAP demonstrated a decreasing trend in both groups, and ultimately restoring to T0 level. However, SpO2 remained stable and then decreased slightly. The differences in HR, SpO2, and MAP levels between the two groups and across different time points were statistically significant (p < 0.05). At T3, the levels of Tau protein, neuron-specific enolase, and glial fibrillary acidic protein were lower in the observation group than in the conventional group (p < 0.05). Furthermore, the observation group demonstrated shorter spontaneous breathing recovery time, eye-opening time, orientation recovery time, extubation time, length of intensive care unit (ICU) stays, and total hospital stay than the conventional group (p < 0.05). Additionally, the incidence rates of arrhythmia and pulmonary infection were lower in the observation group than in the conventional group (p < 0.05). Similarly, the observation group exhibited a better overall prognosis than the conventional group (p < 0.05). CONCLUSIONS:Intravenous anesthesia with remimazolam besylate in patients undergoing surgery for craniocerebral injury can maintain stable hemodynamics, protect neurological function, and promote post-surgery recovery.

Introduction Elderly patients are known to be vulnerable to postoperative pulmonary complications (PPCs), especially pneumonia. Apart from elder age, preoperative pulmonary diseases, anaemia, malnutrition, dysphagia and frailty may all be contributing factors to PPCs. Poor oral hygiene is a risk factor for PPC as well, as oropharyngeal microflora might be introduced to the lower respiratory tract following endotracheal intubation for general anaesthesia during surgery. Immune regulation, nutrition supplementation and improvement of oropharyngeal microflora might regulate immune and stress response and can be beneficial to elderly patients exposed to surgical stress. In this study, we will explore the effects of perioperative oral decontamination and immunonutrition supplementation on the incidence of postoperative pneumonia in high-risk elderly surgical patients.Methods and analysis This study is a multicentre, two-by-two factorial randomised controlled trial evaluating the efficacy of immunonutrition supplementation and oral chlorhexidine decontamination. A total of 592 patients aged 65 years and older who are scheduled for elective non-cardiac surgeries in seven tertiary hospitals in China will be recruited. Patients will be excluded if they have contraindications to the intervention. Patients will be randomised into four groups in a 1:1:1:1 ratio (oral decontamination vs routine oral care, immunonutrition supplementation vs routine nutrition advice). The primary outcome is the incidence of PPCs within 7 days after surgery. The secondary outcomes are the incidence of postoperative pneumonia, infectious complications, Comprehensive Complication Index, postoperative functional recovery, length of hospital stay and hospital expenses. Intention to treat principles will be applied to all outcomes. Descriptive analysis will be used to compare patients’ baseline characteristics. Logistic regression will be used to compare the incidence of PPCs within 7 days after surgery between different groups.Ethics and dissemination The study protocol has been approved by the Research Ethics Committee of Peking Union Medical College Hospital (I-23PJ953). All participants will provide written informed consent. Study results will be published in peer-reviewed journals and presented at academic conferences.Trial registration number NCT05971810.

BACKGROUND:Disorders of consciousness (DoCs) following traumatic brain injury (TBI), or cerebrovascular disease (CVD) are difficult to prognose, as reliable biomarkers are lacking. Resting-state functional magnetic resonance imaging (fMRI) amplitude of low-frequency amplitude (ALFF) may capture etiology-specific neural activity, but its prognostic value for spinal cord stimulation (SCS) outcomes remains unknown. In this study we therefore investigated etiology-specific ALFF patterns in TBI- and CVD-induced DoCs and evaluated their prognostic value for recovery after SCS. METHODS:Resting-state fMRI data from patients with TBI (n = 16) and CVD (n = 15), and healthy controls (n = 12), were analyzed. Whole-brain ALFF differences were also compared between the groups. Correlations between ALFF and 6-month post-SCS Coma Recovery Scale-Revised (CRS-R) score improvements were assessed. Logistic regression was used to identify consciousness recovery markers. RESULTS:Compared with healthy controls, patients with TBI demonstrated a significant increase in ALFF within the bilateral insula, thalamus, and brainstem (p < 0.05), suggesting compensatory neural hyperactivity potentially involving glutamatergic pathways. Patients with CVD exhibited elevated ALFF in the contralateral sensorimotor cortex (p < 0.05), indicating ipsilateral neural reorganization. Notably, the thalamic ALFF were strongly correlated with consciousness recovery, as measured by improvements in CRS-R score at 6 months in both the TBI (r= 0.64, p = 0.0071) and CVD (r = 0.59, p = 0.02) groups. Furthermore, logistic regression analysis identified increased ALFF in the anterior cingulate cortex-thalamic loop (odds ratio [OR] = 3.21, p < 0.05) as a potential cross-etiology biomarker for recovery following SCS. CONCLUSIONS:ALFF reveal distinct neuroplasticity mechanisms, including compensatory activation in TBI and ipsilateral reorganization in CVD. Elevated anterior cingulate cortex (ACC)-thalamic ALFF are a key cross-etiology biomarker for consciousness recovery to guide SCS target selection.

Background:Intrapartum fever is a common complication during labor that may adversely affect both maternal and neonatal outcomes. However, its underlying multifactorial etiology remains incompletely understood. Objective:This study aimed to investigate the clinical and inflammatory factors associated with intrapartum fever and to construct a predictive model for individualized risk assessment. Methods:In this retrospective cohort study, we analyzed clinical data from 1,692 parturients who received epidural analgesia during term singleton vaginal delivery between September 2019 and October 2021. Participants were randomly divided into training and validation sets (7:3). Independent predictors of intrapartum fever were identified using multivariate logistic regression. A nomogram was constructed and evaluated through receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). Results:Intrapartum fever occurred in 5.0% of cases. Seven independent predictors were identified, including admission body temperature, premature rupture of membranes (PROM), duration of the first stage of labor, number of vaginal examinations, interleukin-6 (IL-6), systemic immune-inflammation index (SII), and neutrophil-to-lymphocyte ratio (NLR). Among these, IL-6 and SII demonstrated the strongest predictive performance, with SII showing a higher AUC than NLR (0.846 vs. 0.716). The final nomogram incorporating six variables achieved excellent discrimination (AUC = 0.910 in the training set and 0.906 in the validation set) and demonstrated good calibration and clinical utility. Conclusion:Intrapartum fever is associated with both obstetric stress and systemic inflammation. The proposed nomogram, integrating readily available clinical and inflammatory markers, enables individualized risk assessment and may assist in early identification of high-risk parturients, supporting timely clinical intervention during labor.

To investigate the impact of preoperative anemia incidence of severe complications and short-term clinical outcomes in patients undergoing retroperitoneal tumor resection. We performed a retrospective cohort study, enrolling patients with retroperitoneal tumors who received resection at Peking University International Hospital from January 2015 to December 2023. Patient baseline data were collected, and the following outcome measures were recorded:​ • The primary outcome measure was the grade of postoperative complications; •The secondary outcome measures included duration of mechanical ventilation, length of ICU stay, postoperative hospital stay, total hospital stay, postoperative 24-hour mortality, and postoperative 30-day mortality.​ Patients were divided into an anemia group and a non-anemia group according to the World Health Organization (WHO) criteria for anemia to analyze the effect of preoperative anemia on the aforementioned indicators. A total of 1968 patients were included in this study, among whom 1100 (465 males and 635 females) had preoperative anemia, with an incidence rate of 55.9

Anesthesia plays a pivotal role in modern surgery by facilitating controlled states of unconsciousness. Precise control is crucial for safe and pain-free surgeries. Monitoring anesthesia depth accurately is essential to guide anesthesiologists, optimize drug usage, and mitigate postoperative complications. This study focuses on enhancing the classification performance of anesthesia-induced transitions between wakefulness and deep sleep into eight classes by leveraging advanced graph neural network (GNN). The research combines seven datasets into a single dataset comprising 290 samples and investigates key brain regions, to develop a robust classification framework. Initially, the dataset is augmented using the Synthetic Minority Over-sampling Technique (SMOTE) to expand the sample size to 1197. A graph-based approach is employed to get the intricate relationships between features, constructing a graph dataset with 1197 nodes and 714,610 edges, where nodes represent data samples and edges are the connections between the nodes. The connection (edge weight) is calculated using Spearman correlation coefficient matrix. An optimized GNN model is developed through an ablation study of eight hyperparameters, achieving an accuracy of 92.8%. The model's performance is further evaluated against one-dimensional (1D) CNN, and six machine learning models, demonstrating superior classification capabilities for small and imbalanced datasets. Additionally, we evaluated the proposed model on six different anesthesia datasets, observing no decline in performance. This work advances the understanding and classification of anesthesia states, providing a valuable tool for improved anesthesia management.

Objective To evaluate the preventive drug use of magnesium isoglycyrrhizinate injection beyond the instructions by rapid health technology, and to provide reference for its rational clinical application. Methods The databases such as PubMed, Embase, the Cochrane Library, HowNet, Wanfang, VIP and HTA websites were searched. Two researchers screened the literature to extract data according to the inclusion and exclusion criteria. If necessary, a third researcher was consulted. The included literature was analyzed and concluded through corresponding quality evaluation. Results and Conclusion Four meta-analysis articles and five pharmacoeconomics articles were included. In terms of effectiveness, compared with the blank group and the control group (diammonium glycyrrhizinate, glutathione, and polyene phosphatidylcholine), the preventive use of magnesium isoglycyrrhizinate injection had a lower incidence of drug-induced liver injury with a more significant reduction in the levels of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and total bilirubin. In terms of safety, except for an economic study in which some patients had a transient increase in blood pressure during the use of magnesium isoglycyrrhizinate injection, other studies did not show the increasing risk of adverse reactions due to preventive medication. In terms of economy, the use of magnesium isoglycyrrhizinate injection for prevention of different diseases did not necessarily have economic advantages over the control group (blank group and reduced glutathione, polyene phosphatidylcholine injection, traditional Chinese medicine combined with magnesium isoglycyrrhizinate injection). In the prevention of drug induced liver injury, magnesium isoglycyrrhizinate injection used beyond the instructions has certain efficacy and safety, but it may not be the economic optimal for other different diseases.

IntroductionGlobal signal regression (GSR) is widely used in functional magnetic resonance imaging (fMRI) analysis, yet its effects on anesthetic-related brain activity are not well understood.MethodsUsing fMRI data from patients under general anesthesia, we analyzed temporal variability indices, amplitude of low-frequency fluctuations, functional connectivity, and graph theoretical measures with and without GSR.ResultsHere we show that GSR differentially affects brain activity patterns during propofol- and sevoflurane-induced unconsciousness. While temporal variability indices decreased similarly between conscious and unconscious states regardless of GSR, functional connectivity analyses revealed anesthetic-specific effects: GSR altered specific network connections under propofol but broadly reduced connectivity differences under sevoflurane. Network topology analyses demonstrated that GSR minimally affected propofol-induced changes in graph theoretical measures but significantly diminished sevoflurane-related network alterations.DiscussionThese findings reveal that GSR’s impact on functional brain organization is anesthetic-specific, with sevoflurane-induced changes being particularly sensitive to global signal removal. Our results suggest that GSR should be applied cautiously when comparing different anesthetic agents and highlight the importance of considering drug-specific effects when analyzing consciousness-related brain activity.