BACKGROUND:Intracranial atherosclerotic stenosis is a prevalent cause of stroke worldwide and carries a high risk of recurrence. This study aimed to develop and validate a simple and effective model for predicting individualised risks of recurrent ischaemic stroke in patients with symptomatic intracranial atherosclerotic stenosis (ICAS). METHODS:This multivariable prediction model was built and validated using participants with symptomatic ICAS within 30 days of symptom onset from a large randomised controlled trial (RICA). The trial enrolled 3033 participants across 84 hospitals in China between Oct 28, 2015, and Feb 28, 2019. Participants were non-randomly divided by hospitals location into training and validation sets. Eligible participants were aged 40-80 years and had experienced an ischaemic stroke or transient ischaemic attack attributable to 50-99% stenosis of a major intracranial artery. The primary outcome of the model was time to first ischaemic stroke recurrence within 1 year. A Cox proportional hazards model was developed using the Akaike information criterion and validated both internally and externally. Model performance was assessed by discrimination (Harrell's concordance index [C-index]), calibration (modified Hosmer-Lemeshow test and calibration plots), and clinical utility (decision curve analysis and Kaplan-Meier curves). FINDINGS:2995 participants from the RICA trial were divided into the training (n=2137) and validation (n=858) sets. The PROMISE model included age, BMI, hypertension, type 1 and type 2 diabetes, current smoking status, LDL cholesterol, location of symptomatic stenosis, and stenosis degree of qualifying artery as predictors. The C-index for the prediction model was 0·81 (95% CI 0·80-0·83) in the training set and 0·78 (0·77-0·84) in the validation set. Model calibration was satisfactory across the full risk profile (modified Hosmer-Lemeshow test χ2=5·32, p=0·38). Furthermore, decision curve analysis curves indicated that this prediction model provided clinical benefits. Additionally, participants were classified into three distinct risk groups (low, medium, and high) by Kaplan-Meier curves based on the prediction model. The corresponding C-indices for these groups were 0·80 (95% CI 0·80-0·86), 0·68 (0·67-0·77), and 0·71 (0·69-0·81) in the training set, and 0·76 (0·75-0·88), 0·67 (0·65-0·82), and 0·68 (0·67-0·86) in the validation set. Based on the final model, an online risk calculator was developed. INTERPRETATION:We developed the PROMISE model and an online calculator using accessible clinical variables to predict ischaemic stroke recurrence, identify individuals at high risk, and support symptomatic ICAS patient management. The model had a strong discriminative ability and good calibration. Further validation and model optimisation should be conducted to support stroke care. FUNDING:National Natural Science Foundation of China, Beijing Natural Science Foundation, Noncommunicable Chronic Diseases-National Science and Technology Major Project, and Beijing Physician Scientist Training Project.

BACKGROUND:Implementing a standardized perioperative care program can enhance clinical practices for elderly patients undergoing lumbar fusion surgery (LFS). Multimodal prehabilitation and enhanced recovery after surgery (ERAS) protocols are extensively employed as evidence-based protocols for a continuous perioperative management across various surgical fields. The aim of this study is to use the Delphi method, a validated consensus-building technique, to reach a consensus among a panel of Chinese experts on the essential components of prehabilitation and ERAS for older patients undergoing elective LFS. METHODS:The study used a 3-round modified Delphi method to reach a consensus among Chinese experts. The process involves the establishment of a core group and expert panel, questionnaire development and distribution, independent scoring by experts, an online meeting for discussion and revision of scores, and final statistical analysis of the results. RESULTS:A total of 30 experts major in spine surgery, anesthesia, nursing, and geriatrics were invited from 14 different provinces and cities across China to participate in the survey. After 2 rounds of expert surveys and 1 online meeting discussion, the final protocols included 23 elements, with an approval rate that exceeded 80%. CONCLUSIONS:Using a modified Delphi process, we developed a comprehensive protocol that combines prerehabilitation and ERAS for elderly patients undergoing elective LFS encompassing 23 different interventions. The multidisciplinary experts recommend incorporating these measures into the perioperative care for elderly patients undergoing LFS surgery.

IntroductionThis study aimed to evaluate the prevalence of frailty and to identify its associated risk factors in hospitalized patients with Sjögren’s disease (SjD).MethodsA cross-sectional study was conducted among hospitalized SjD patients at Xuanwu Hospital between August 2022 and October 2024. Frailty was evaluated using the Fried Frailty Phenotype, which comprises five components: unintentional weight loss, self-reported exhaustion, low physical activity, slowness, and weakness. Based on established criteria, patients were categorized as frail (≥3 criteria), pre-frail (1–2 criteria), or robust (0 criteria).ResultsA total of 180 patients were included in the final analysis. The prevalence of frailty and pre-frailty was 27% and 49%, respectively. Multivariate logistic regression analyses identified higher c-reactive protein (OR = 1.080, 95% CI: 1.020-1.144, P = 0.008), the EULAR Sjögren’s Syndrome Disease Activity Index (OR = 1.082, 95% CI: 1.027-1.140, P = 0.003), and EULAR Sjögren’s Syndrome Patient Reported Index (OR = 1.271, 95% CI: 1.064-1.518, P = 0.008) as independent risk factors for frailty.ConclusionsFrailty is commonly observed among hospitalized patients with SjD and is independently associated with systemic inflammation and disease activity. These findings underscore the need for routine frailty assessment in clinical practice, particularly among patients with elevated inflammatory markers and more severe disease manifestations.

OBJECTIVES:This systematic review and meta-analysis aimed to update the global prevalence of stroke and transient ischemic attack (TIA) in Takayasu arteritis (TA) patients, assess subgroup variations, and identify modifiable risk factors. METHODS:Following PRISMA and MOOSE guidelines, eight databases (PubMed, EMBASE, Web of Science, Medline, and four Chinese databases) were systematically searched up to January 2025. A random-effects model was used to pool prevalence estimates, with subgroup analyses and risk factor evaluations. Heterogeneity was quantified using the I2 statistic, and publication bias was assessed via funnel plots and Egger's test. RESULTS:Thirty-four observational cohort studies (5112 patients involved) were included. The pooled prevalence of stroke/TIA in TA patients was 10.7% (95% CI: 8.4%-13.6%), with high heterogeneity (I2=90.4%). Subgroup analyses revealed higher prevalence of stroke/TIA in males than in females (20% vs. 11%), and in European populations (13%). Ischemic stroke predominated (7%, I2=80.7%), while hemorrhagic stroke was rare (2%, I2=0%). Smoking was the sole significant modifiable risk factor (RR=1.64, 95% CI: 1.13-2.38). Stroke accounted for 21.2% of all TA-related deaths. CONCLUSIONS:TA patients face a high burden of stroke/TIA, with marked heterogeneity driven by population and methodological differences. Males and Europeans have higher prevalence of stroke/TIA. Smoking is the only modifiable risk factor in TA patients with stroke/TIA.

Purpose:Perioperative neurocognitive disorder (PND) is common in elderly surgical patients and severely affects postoperative recovery. However, effective prevention is still lacking. Potential perioperative cerebral stressors (including inappropriate sedative/analgesic depth and imbalanced cerebral oxygen supply/demand) may be important contributing factors. We developed an anesthesia management protocol based on multimodal brain monitoring to achieve standardized, individualized, and real-time regulation of sedative/analgesic depth and cerebral oxygen saturation and investigated whether it could reduce the incidence of PND and its underlying mechanisms. Patients and Methods:Patients (aged ≥65 years) were randomized into Groups C (n=88) and E (n=93). Patients in Group E received multimodal brain monitoring-guided anesthesia management, and those in Group C received BIS-guided anesthesia management. The Montreal Cognitive Assessment (MoCA) was performed both before and seven days after surgery. The postoperative pain scores were recorded. Resting-state functional MRI data were analyzed to examine functional connectivity (FC). Results:Group E demonstrated a numerically lower incidence of PND (15.50% vs 21.59% in Group C), but this difference was not statistically significant. Patients in Group E had increased FC within the right pulvinar, right sub-gyral region, and right inferior parietal lobule (P < 0.05). Significantly lower pain scores were observed in Group E at rest (1h: P=0.04; 24h: P=0.04) and during movement (1h: P=0.03). Conclusion:These results suggest that multimodal brain monitoring-guided anesthesia management may protect neurocognition by enhancing FC within cognition-associated brain regions and attenuating postoperative acute pain. And multimodal brain monitoring-guided anesthesia management may confer a clinically relevant reduction in PND incidence compared to BIS-guided management in elderly surgical patients.

Background Although previous studies have suggested that left ventricular ejection fraction (LVEF) adjusted by left ventricular mass (LVM) might improve prognostic risk stratification of cardiac events, few prospective cohort studies have examined its clinical implications. We assessed the predictive ability of LVEF indexed to LVM, body surface area (BSA), and body mass index for the cardiac event risk. Methods We conducted a 5.52‐year cohort study on the association between LVEF indexed to LVM and cardiac events among 4266 participants with mildly reduced or preserved LVEF. Multivariable Cox regression analysis incorporating restricted cubic spline functions evaluated the predictive ability of LVEF, LVEF/LVM, and other indexed measures. Results After multivariable Cox regression adjustment, LVEF/LVM, LVEF/LVM/BSA, and LVEF/LVM/body mass index remained significantly associated with cardiac events (all P<0.05), whereas LVEF alone was not (P=0.569). Restricted cubic spline analysis identified a nonlinear approximately U‐shaped relationship for both LVEF/LVM and LVEF/LVM/BSA (both P for nonlinearity<0.001). Compared with the middle reference group, participants in the low LVEF/LVM (hazard ratio [HR], 2.00 [95% CI, 1.08–3.71]) and low LVEF/LVM/BSA (HR, 2.13 [95% CI, 1.11–4.07]) groups had significantly higher risks. While the high groups showed nonsignificant differences (LVEF/LVM: HR, 1.41 [95% CI, 0.68–2.95]; LVEF/LVM/BSA: HR, 1.39 [95% CI, 0.65–2.99]), the observed risk pattern indicated that values outside the ranges of 4.72 to 5.53/kg (LVEF/LVM) and 19.7 to 24.3 m2/kg2 (LVEF/LVM/BSA) suggested a higher cardiac event risk. Conclusions LVEF indexed to LVM provides better cardiac event risk stratification than LVEF alone in individuals with mildly reduced or preserved ejection fraction.

INTRODUCTION:Postoperative neurocognitive disorders (PNDs) are common postoperative complications that can hinder patients' postoperative recovery. Various studies have investigated the correlations between PNDs and cerebrospinal fluid (CSF) neuroinflammatory biomarkers in orthopedic patients. However, combined evidence is required to confirm the homogeneity and robustness of these findings. METHODS:Observational studies were searched to explore the associations between PNDs and these biomarkers in orthopedic patients. A comprehensive study retrieval was performed in MEDLINE (via OVID), EMBASE, and the Cochrane Library without any restrictions on language or date. Subgroup and sensitivity analyses were performed to confirm robustness of the results. RESULT:A total of 27 articles were included in this study. Significant concentration differences were found between PNDs and non-PNDs groups in the majority of preoperative CSF neuroinflammatory biomarkers, particularly in patients with postoperative delirium (POD) and delayed neurocognitive recovery (dNCR). Moderate quality evidence identified that increased preoperative CSF levels of t-Tau (OR: 1.008, 95%CI: 1.005-1.010) and p-Tau (OR: 1.077, 95%CI: 1.042-1.078), along with decreased Aβ42 level (OR: 0.998, 95% CI: 0.997-0.999), were risk factors for POD in orthopedic patients. Low quality evidence suggested that preoperative CSF level of Aβ42/t-Tau was a valuable predictive biomarker for dNCR. CONCLUSION:Different subtypes of PNDs after orthopedic surgery have different CSF biomarkers, with POD having the most and postoperative neurocognitive disorder (POCD) having the fewest. Studies concerning dNCR and POCD are needed to investigate their correlations with these biomarkers. Meanwhile, studies concerning diagnostic tests are also highly needed to help screen for practical biomarkers and analyze these biomarkers from a more comprehensive perspective.

Abstract: BACKGROUND: To assess the effectiveness of incorporating simple carotid ultrasound markers into modifiable conventional vascular risk factors (C-VRFs) on identifying the high-risk stroke population. METHODS: A community-based cohort study involving 3,506 participants (mean [standard deviation] age: 61.3 [12.8] years; 41.8% male), all of whom were free of stroke and atrial fibrillation at baseline, underwent carotid ultrasound assessment. The asymptomatic carotid atherosclerosis (ACS) was assessed by detecting increased carotid intima–media thickness and plaques with or without stenosis. The new stroke events occurring during a 5.5-year follow-up were recorded. Nomograms for stroke probability by adding ACS to C-VRFs constructed models were developed and validated. RESULTS: Integrating ACS into C-VRF models further improved the models’ performance for stroke prediction. Neither additive nor multiple interactions of ACS and C-VRFs existed. While comparing with group of none/mild ACS and C-VRFs < 3, the risk of total stroke in the group with plaque and C-VRFs ≥ 3 increased by 2.6 times (hazard ratios [HRs]: 2.55, 95% confidence interval [CI]: 1.62–4.00) after adjusting for age and gender. The elevated stroke risk in the group of plaques with C-VRFs < 3 (HR: 1.88, 95% CI: 1.17–3.01) was equivalent to that with none/mild ACS and C-VRFs ≥ 3 (HR: 1.85, 95% CI: 1.12–3.00). In the group with C-VRFs < 3, 42.5% subjects had plaques, and 84% of those plaque-positive subjects were ≥ 60 years old. Moreover, the prevalence of nonstenosis and intermediate stenosis plaques was the highest, with the largest new stroke event occurring during the follow-up period. CONCLUSION: Adding ACS to multiple C-VRFs may improve high-risk stroke individual identification in the general population. While this modality may overlook the high-risk stroke population having plaques with C-VRFs < 3, in older adults.

Summary Background The environmental effects on the prognosis of ocular myasthenia gravis (OMG) remain largely unexplored. Aim To investigate the association between specific environmental factors and the generalization of OMG. Design The cohort study was conducted in China based on a nationwide multicenter database. Methods Adult patients with OMG at onset, who were followed up for at least 2 years until May 2022, were included. We collected data on demographic and clinical factors, as well as environmental factors, including latitude, socioeconomic status (per capita disposable income [PDI] at provincial level and education) and smoking. The study outcome was the time to the development of generalized myasthenia gravis (GMG). Cox models were employed to examine the association between environmental exposures and generalization. Restricted cubic spline was used to model the association of latitude with generalization risk. Results A total of 1396 participants were included. During a median follow-up of 5.15 (interquartile range [IQR] 3.37–9.03) years, 735 patients developed GMG within a median of 5.69 (IQR 1.10–15.66) years. Latitude of 20–50°N showed a U-shaped relation with generalization risk, with the lowest risk at around 30°N; both higher and lower latitudes were associated with the increased risk (P for non-linearity <0.001). Living in areas with lower PDI had 1.28–2.11 times higher risk of generalization. No significant association was observed with education or smoking. Conclusions Latitude and provincial-level PDI were associated with the generalization of OMG in China. Further studies are warranted to validate our findings and investigate their potential applications in clinical practice and health policy.

The Beijing Healthy Aging Cohort Study (BHACS) was established to supplement the limited data of a large representative cohort of older people based on the general population and was designed to evaluate the prevalence, incidence, and natural history of cognitive decline, functional disability, and conventional vascular risk factors. The aim was to determine the evolution of these conditions by estimating the rates and determinants of progression and regression to adverse outcomes, including dementia, cardiovascular events, cancer, and all-cause death. It can therefore provide evidence to help policy makers develop better policies to promote healthy aging in China. BHACS consisted of three cohorts (BLSA, CCHS-Beijing, and BECHCS) in Beijing with a total population of 11 235 (6281 in urban and 4954 in rural areas) and an age range of 55 years or older (55–101 years) with a mean age of 70.35 ± 7.71 years (70.69 ± 7.62 years in urban and 69.92 ± 7.80 years in rural areas). BHACS-BLSA conducted the baseline survey in 2009 with a multistage stratification-random clustering procedure for people aged 55 years or older; BHACS-CCHS-Beijing conducted the baseline survey in 2013–2015 with a stratified multistage cluster random sampling method for people aged 55 years or older; and BHACS-BECHCS conducted the baseline survey in 2010–2014 with two-stage cluster random sampling method for people aged 60 years or older. Data were collected through questionnaires, physical measurements, and laboratory analyses. Topics covered by BHACS include a wide range of physical and mental health indicators, lifestyles and personal, family, and socio-economic determinants of health. There are no immediate plans to make the cohort data freely available to the public, but specific proposals for further collaboration are welcome. For further information and collaboration, please contact the corresponding author Yao He (e-mail: yhe301@x263.net).

BACKGROUND:The primary objective of anesthesiologists during the induction of anaesthesia is to mitigate the operative stress response resulting from endotracheal intubation. In this prospective, randomized controlled trial, our aim was to assess the feasibility and efficacy of employing Index of Consciousness (IoC, IoC1 and IoC2) monitoring in predicting and mitigating circulatory stress induced by endotracheal intubation for laparoscopic cholecystectomy patients under general anesthesia (GA). METHODS:We enrolled one hundred and twenty patients scheduled for laparoscopic cholecystectomy under GA and randomly allocated them to two groups: IoC monitoring guidance (Group T, n = 60) and bispectral index (BIS) monitoring guidance (Group C, n = 60). The primary endpoints included the heart rate (HR) and mean arterial pressure (MAP) of the patients, as well as the rate of change (ROC) at specific time points during the endotracheal intubation period. Secondary outcomes encompassed the systemic vascular resistance index (SVRI), cardiac output index (CI), stroke volume index (SVI), ROC at specific time points, the incidence of adverse events (AEs), and the induction dosage of remifentanil and propofol during the endotracheal intubation period in both groups. RESULTS:The mean (SD) HR at 1 min after intubation under IoC monitoring guidance was significantly lower than that under BIS monitoring guidance (76 (16) beats/min vs. 82 (16) beats/min, P = 0.049, respectively). Similarly, the mean (SD) MAP at 1 min after intubation under IoC monitoring guidance was lower than that under BIS monitoring guidance (90 (20) mmHg vs. 98 (19) mmHg, P = 0.031, respectively). At each time point from 1 to 5 min after intubation, the number of cases with HR ROC of less than 10% in Group T was significantly higher than in Group C (P < 0.05). Furthermore, between 1 and 3 min and at 5 min post-intubation, the number of cases with HR ROC between 20 to 30% or 40% in Group T was significantly lower than that in Group C (P < 0.05). At 1 min post-intubation, the number of cases with MAP ROC of less than 10% in Group T was significantly higher than that in Group C (P < 0.05), and the number of cases with MAP ROC between 10 to 20% in Group T was significantly lower than that in Group C (P < 0.01). Patients in Group T exhibited superior hemodynamic stability during the peri-endotracheal intubation period compared to those in Group C. There were no significant differences in the frequencies of AEs between the two groups (P > 0.05). CONCLUSION:This promising monitoring technique has the potential to predict the circulatory stress response, thereby reducing the incidence of adverse reactions during the peri-endotracheal intubation period. This technology holds promise for optimizing anesthesia management. TRAIL REGISTRATION:Chinese Clinical Trail Registry Identifier: ChiCTR2300070237 (20/04/2022).

Purpose: We aimed to identify the risk factors for postoperative cognitive decline (POCD) by evaluating the outcomes from preoperative comprehensive geriatric assessment (CGA) and intraoperative anesthetic interventions. Patients and Methods: Data used in the study were obtained from the Aged Patient Perioperative Longitudinal Evaluation-Multidisciplinary Trial (APPLE-MDT) cohort recruited from the Department of Orthopedics in Xuanwu Hospital, Capital Medical University between March, 2019 and June, 2022. All patients accepted preoperative CGA by the multidisciplinary team using 13 common scales across 15 domains reflecting the multi-organ functions. The variables included demographic data, scales in CGA, comorbidities, laboratory tests and intraoperative anesthetic data. Cognitive function was assessed by Montreal Cognitive Assessment scale within 48 hours after admission and after surgery. Dropping of >1 point between the preoperative and postoperative scale was defined as POCD. Results: We enrolled 119 patients. The median age was 80.00 years [IQR, 77.00, 82.00] and 68 patients (57.1%) were female. Forty-two patients (35.3%) developed POCD. Three cognitive domains including calculation (P = 0.046), recall (P = 0.047) and attention (P = 0.007) were significantly worsened after surgery. Univariate analysis showed that disability of instrumental activity of daily living, incidence rate of postoperative respiratory failure (PRF) >= 4.2%, STOP -Bang scale score, Caprini risk scale score and Sufentanil for maintenance of anesthesia were different between the POCD and non-POCD patients. In the multivariable logistic regression analysis, PRF >= 4.2% (odds ratio [OR] = 2.343; 95% confidence interval [CI]: 1.028-5.551; P = 0.046) and Sufentanil for maintenance of anesthesia (OR = 0.260; 95% CI: 0.057-0.859; P = 0.044) was independently associated with POCD as risk and protective factors, respectively. Conclusion: Our study suggests that POCD is frequent among older patients undergoing elective orthopedic surgery, in which decline of calculation, recall and attention was predominant. Preoperative comprehensive geriatric assessments are important to identify the high-risk individuals of POCD.

BACKGROUND:NLRP3 inflammasome-related inflammation might play an important role in the pathophysiology of severe CVT. The use of steroids as anti-inflammatory agents in improving severe CVT prognosis remains controversial. METHODS:A total of 94 male Sprague-Dawley rats were used. We evaluated the dynamic and association between NLRP3 inflammasome in brain, blood, and CSF and severity in severe CVT rats and/or patients. We also explored the effect of steroids on NLRP3 activation, neurological injury, and CSF circulation disturbance after CVT in animals and/or patients. RESULTS:In rats, compared with the sham group, NLRP3-related factors rose on day 1, peaked on day 2 (NLRP3, Sham: 0.79 ± 0.22; day 2: 1.25 ± 0.08, p < 0.01; pro-Caspase-1, Sham: 0.58 ± 0.13, day 2: 1.20 ± 0.44, p < 0.05; GSDMD, Sham: 0.94 ± 0.22, day 2: 1.72 ± 0.46, p < 0.05; pro-IL-1β, Sham: 0.74 ± 0.15, day 2: 1.35 ± 0.09, p < 0.01), decreased on day 7 in rats (n = 4 per group). Thrombus (Sham: 0.00 ± 0.00, day 2: 3.44 ± 0.70, p < 0.0001), infarct size (Sham: 0.00 ± 0.00, day 2: 11.99 ± 6.26, p < 0.01) and neurological deficits appeared similar trend. In 50 patients, serum NLRP3 and IL-6 levels correlated positively with NIHSS (r = 0.4273, p = 0.0020; r = 0.4938, p = 0.0029) and mRS (r = 0.5349, p = 0.0125; r = 0.6213, p = 0.026), while CSF IL-6 correlated positively with mRS on admission (r = 0.5349, p = 0.0125). Compared with baseline, NLRP3 (0.36 (0.36, 0.36) vs. 0.41 (0.37, 0.84), p < 0.0001) and IL-6 decreased (4.06 ± 1.48 vs. 12.03 ± 7.80, p < 0.05), accompanying by improvement of neurological deficits and CSF circulation (all p < 0.01) after steroids therapy in severe CVT patients at discharge and 3 months follow-up. No significant steroid-related adverse effects were observed. CONCLUSION:Short-term steroid therapy may improve prognosis of severe CVT by suppressing NLRP3 inflammasome-related inflammation.

Objective: To investigate the frailty, as estimated by accumulated health deficits, in association with the symp-tomatic carotid atherosclerosis and in relation to five-year cardiovascular (CVD) outcomes. Methods: This is a five-year prospective cohort study. Secondary analysis of data from the Beijing Longitudinal Study on Aging. Community-dwelling people aged 55+ years (n = 1257) have been followed between 2009 and 2014, and having carotid ultrasonography examinations with no CVD events at baseline. Frailty was quantified using the deficit accumulation-based frailty index (FI), constructed from 37 health deficits assessed at baseline. The association between the degree of frailty and carotid atherosclerosis was examined using odds ratios (OR) with multivariate logistic regression analyses. Effects of frailty on the probability of five-year cardiovascular events and mortality were evaluated using Cox proportional hazard ratios (HR). The analyses were adjusted for demographics, baseline carotid atherosclerosis status, and CVD risk factors. Results: The FI showed characteristic properties and was independently associated with the major carotid atherosclerosis symptoms, including carotid artery intima-media thickening (the most frail vs. the least frail: OR = 4.39: 1.98-7.82), carotid plaque (OR = 3.41: 1.28-6.54), and carotid plaque stability (OR = 1.19, 95 % CI: 1.01-3.59). Compared with the least frail, the most frail individuals were more likely to develop a cardiovascular event in five years, including myocardial infarction (HR = 3.38, 95 % CI = 1.84-6.19), stroke (HR = 1.26, 95 % CI = 1.00-5.87), CVD death (HR = 6.33, 95 % CI = 1.69-11.02), and all-cause death (HR = 5.95, 95 % CI = 2.74-8.95). Conclusion: Deficit accumulation was closely associated with carotid atherosclerosis risks and strongly predicted five-year CVD events. The frailty index can be used to help identify older adults at high risks of CVD for improved preventive healthcare.

目的 探究合并脑卒中病史的高龄(≥75岁)患者术中SBP降低与术后新发缺血性脑卒中的相关性.方法 选择2019年1月至2022年4月入住首都医科大学宣武医院,在麻醉下行非心脏手术且合并陈旧性脑卒中病史的高龄患者.病例组为手术后至出院前出现新发缺血性脑卒中的患者,对照组患者术后没有出现新发的缺血性脑卒中.按1∶4的匹配比例将病例组(24例)和对照组(96例)按照年龄和术式进行匹配.从病历记录系统和麻醉信息系统中分别采集术前、术中和术后的相关数据.计算术中SBP的最大降低幅度和最低值.比较病例组和对照组的人口统计学资料与可能的混杂因素.用条件Logistic回归分析术中SBP降低与术后新发缺血性脑卒中的相关性.结果 与对照组比较,病例组的人口统计学参数和可能的混杂因素差异无统计学意义(P＞0.05).病例组术中SBP最大降低幅度＜10％基线值、在10％～20％基线值的比例低于对照组(P＜0.05),术中SBP最大降低幅度＞20％基线值的比例高于对照组(P＜0.05).病例组院内病死率及住院花费高于对照组(P＜0.05).与SBP最大降低幅度＜10％基线值比较,最大降低幅度＞20％基线值可增加术后新发缺血性脑卒中的风险[比值比(odd ratio,OR)11.909,95％CI 1.992～71.212,P=0.007].与术中最低 SBP＞120 mmHg(1 mmHg=0.133 kPa)比较,术中最低 SBP 为 100～120 mmHg可增加术后新发缺血性脑卒中的风险(OR 3.769,95％CI1.186～11.975,P=0.025).结论 术后出现新发缺血性脑卒中可显著增加合并陈旧性脑卒中病史的高龄患者院内病死率和住院花费.SBP最大降低幅度＞20％基线值和最低SBP为100～120 mmHg均可显著增加术后新发缺血性脑卒中的风险.

Abstract Background Dexmedetomidine has analgesic properties, but the intraoperative analgesic effect of dexmedetomidine is often masked by the effects of other general anaesthetics. Therefore, the degree to which it reduces intraoperative pain intensity remains unclear. The objective of this double-blind, randomised controlled trial was to evaluate the independent intraoperative analgesic efficacy of dexmedetomidine in real-time. Methods This single-centre study enrolled 181 patients who were hospitalised for below-knee orthopaedic surgeries between 19 January 2021 to 3 August 2021 were eligible for this is single-centre study. Peripheral neural block was performed on patients scheduled for below-knee orthopaedic surgeries. Patients were randomly assigned to the dexmedetomidine or midazolam group and were intravenously administered with 1.5 µg kg−1 h−1 dexmedetomidine or 50 µg kg−1 h−1 midazolam, respectively. The analgesic efficacy was evaluated using the real-time non-invasive nociception monitoring. The primary endpoint was the attainment rate of the nociception index target. The secondary endpoints included the occurrence of intraoperative hypoxemia, haemodynamic parameters, the consciousness index, electromyography and patient outcomes. Results On Kaplan–Meier survival analysis, the defined nociception index target was attained in 95.45% and 40.91% of patients receiving dexmedetomidine and midazolam, respectively. Log-rank analysis revealed that the dexmedetomidine group attained the nociception index target significantly faster and the median attainment time of the nociception index target in the dexmedetomidine group was 15 min. Dexmedetomidine group was associated with a significantly lower incidence of hypoxemia. There was no significant difference in blood pressure between the dexmedetomidine and midazolam groups. Further, the dexmedetomidine group had a lower maximum visual analogue scale score and lower analgesic consumption postoperatively. Conclusions Dexmedetomidine has independent analgesia and systemically administered as an adjuvant agent has better analgesic efficacy than midazolam without severe side effects. Trial registration clinicaltrial.gov Registry Identifier: NCT-04675372.Registered on 19/12 /2020.

BACKGROUND:There has been limited research regarding the effect of preventive precise multimodal analgesia (PPMA) on the duration of acute postoperative pain after total laparoscopic hysterectomy (TLH). This randomized controlled trial aimed to evaluate how PPMA affects pain rehabilitation.OBJECTIVES:Our primary objective was to reduce the duration of acute postoperative pain after TLH, including incisional and visceral pain.STUDY DESIGN:A double blind randomized controlled clinical trial.SETTING:Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.METHODS:Seventy patients undergoing TLH were randomized to Group PPMA or Group Control (Group C) in a 1:1 ratio. Patients in Group PPMA were given PPMA through the pre-incisional administration of parecoxib sodium 40 mg (parecoxib is not approved for use in the US) and oxycodone 0.1 mg/kg as well as local anesthetic infiltration at the incision sites. In Group C, similar doses of parecoxib sodium and oxycodone were injected during uterine removal, and a local anesthetic infiltration procedure was performed immediately before skin closure. The index of consciousness 2 was utilized to titrate the remifentanil dosage in all patients to ensure sufficient analgesia.RESULTS:Compared with the Control, PPMA shortened the durations of incisional and visceral pain at rest (median, interquartile range [IQR]: 0, 0.0- 2.5) vs 2.0, 0.0-48.0 hours, P = 0.045; 24.0, 6.0-24.0 vs 48.0, 24.0-48.0 hours, P < 0.001; and during coughing 1.0, 0.0-3.0 vs 24.0, 0.3-48.0 hours, P = 0.001; 24.0, 24.0-48.0] vs 48.0, 48.0-72.0] hours, P < 0.001). The Visual Analog Scale (VAS) scores for incisional pain within 24 hours and visceral pain within 48 hours in Group PPMA were lower than those in Group C (P < 0.05). PPMA evidently decreased the VAS scores for incisional pain during coughing at 48 hours (P < 0.05). Pre-incisional PPMA significantly reduced postoperative opioid consumption (median, IQR: 3.0 [0.0-3.0] vs 3.0 [0.8-6.0] mg, P = 0.041) and the incidence of postoperative nausea and vomiting (25.0% vs 50.0%, P = 0.039). Postoperative recovery and hospital stay were similar between the 2 groups.LIMITATIONS:This research had some limitations, including that it was a single-center research with a limited sample size. Our study cohort did not represent the overall patient population in the People's Republic of China; therefore, the external validity of our findings remains limited. Furthermore, the prevalence of chronic pain was not tracked.CONCLUSION:Pre-incisional PPMA may enhance the rehabilitation process of acute postoperative pain after TLH.

This study aimed to clarify the role of glutamine in atherosclerosis and its participating mechanism. Forty C57BL/6J mice were divided into wild control (wild Con), ApoE − / − control (ApoE − / − Con), glutamine + ApoE − / − control (Glut + ApoE − / − Con), ApoE − / − high fat diet (ApoE − / − HFD), and glutamine + ApoE − / − HFD (Glut + ApoE − / − HFD) groups. The degree of atherosclerosis, western blotting, and multiomics were detected at 18 weeks. An in vitro study was also performed. Glutamine treatment significantly decreased the degree of aortic atherosclerosis ( p = 0.03). O ‐GlcNAcylation ( O ‐GlcNAc), IL‐1β, IL‐1α, and pyruvate kinase M2 (PKM2) in the ApoE − / − HFD group were significantly higher than those in the ApoE − / − Con group ( p < 0.05). These differences were attenuated by glutamine treatment ( p < 0.05), and aggravated by O ‐GlcNA transferase (OGT) overexpression in the in vitro study ( p < 0.05). Multiomics showed that the ApoE − / − HFD group had higher levels of oxidative stress regulatory molecules (guanine deaminase [GUAD], xanthine dehydrogenase [XDH]), proinflammatory regulatory molecules (myristic acid and myristoleic acid), and stress granules regulatory molecules (caprin‐1 and deoxyribose‐phosphate aldolase [DERA]) ( p < 0.05). These differences were attenuated by glutamine treatment ( p < 0.05). We conclude that glutamine supplementation might alleviate atherosclerosis through downregulation of O ‐GlcNAc, glycolysis, oxidative stress, and proinflammatory pathway.

INTRODUCTION:Postoperative neurocognitive disorders (PNDs) are characterised by gradual cognitive decline or change occurring after anaesthesia and surgery, and they are common in patients undergoing orthopaedic surgery. The onset of PNDs has been associated with dementia or other types of neurocognitive disorders in later life. Moreover, cerebrospinal fluid (CSF) biomarkers of neuroinflammation, including amyloid beta-40 peptide, amyloid beta-42 peptide, total tau protein, phosphorylated tau protein and neurofilament light chain, have been reported to be crucial in several high-quality clinical studies on PNDs. However, the role of these biomarkers in the onset of PNDs remains controversial. Therefore, this study aims to determine the association between CSF biomarkers of neuroinflammation and the onset of PNDs in patients undergoing orthopaedic surgery, which will provide novel insights for investigating PNDs and other types of dementia.METHODS AND ANALYSIS:This systematic review and meta-analysis will be conducted in accordance with the Preferred Reporting Items for Systematic Reviewd and Meta-Analyses 2020 statement. Moreover, we will search MEDLINE (via OVID), EMBASE and the Cochrane Library without any language and date restrictions. Observational studies will be included. Two reviewers will independently perform the entire procedure, and disagreements will be settled by discussion between them and consultation with a third reviewer. Standardised electronic forms will be generated to extract data. The risk of bias in the individual studies will be evaluated using the Newcastle-Ottawa scale. All statistical analyses will be performed using the RevMan software or the Stata software.ETHICS AND DISSEMINATION:This study will include peer-reviewed published articles; thus, no ethical issues will be involved. Further, the final manuscript will be published in a peer-reviewed journal.PROSPERO REGISTRATION NUMBER:CRD42022380180.

Background The current study aimed to investigate the incidence and risk factors for postoperative acute ischemic stroke (PAIS) in advanced-aged patients (≥ 75 years) with previous ischemic stroke undergoing noncardiac surgery. Methods In this single-center retrospective cohort study, all advanced-aged patients underwent noncardiac surgery from 1 January, 2019, to 30 April, 2022. Data were extracted from hospital electronic medical records. Multivariable logistic regression analysis was performed to determine predictors of PAIS. Multivariable linear or logistic regression analysis was performed to determine predictors of outcomes due to PAIS. Results Twenty-four patients (6.0%) of the 400 patients developed PAIS. Carotid endarterectomy (CEA), length of surgery and preoperative Modified Rankin scale (mRS) ≥ 3 were significant predictors of PAIS. CEA was associated with increased risk of PAIS (OR 4.14; 95%CI, 1.43–11.99). Each additional minute in length of surgery had slightly increased the risk of PAIS (OR, 1.01; 95%CI, 1.00-1.01). Compared with reference (mRS < 3), mRS ≥ 3 increased odds of PAIS (OR, 4.09;95%CI, 1.12–14.93). Surgery type and length of surgery were found to be significant predictors of in-hospital expense ( P < 0.001) and hospital stays ( P < 0.05). Conclusions CEA, length of surgery and preoperative mRS ≥ 3 may increase the development of PAIS in advanced-aged patients (≥ 75 years) with previous stroke undergoing noncardiac surgery. PAIS increased in-hospital mortality and prolonged hospital stay.