OBJECTIVE:Deep learning-based automated analysis of transgastric short-axis view (TSV) transesophageal echocardiography (TEE) remains under-explored. In this study, we propose a deep learning-based method for fully automated left ventricular segmentation and ejection fraction (EF) prediction in TSV TEE videos. METHODS:We built upon the U-Net network and proposed an Echo Efficient U-Net (Echo-EU-Net) segmentation model by replacing the original standard convolutions with depth-wise separable convolutions and by introducing the Multi-Efficient Channel Attention (MECA) and Enhanced Atrous Spatial Pyramid Pooling (EASPP) modules. We also incorporated automatic cardiac phase tracking and EF calculation. Experiments were performed on a TSV TEE dataset containing 694 videos from 451 patients, with expert manual segmentations and manual EF measurements as the reference standard. RESULTS:The proposed Echo-EU-Net, with an average Dice similarity coefficient of 92.91% and a Jaccard similarity coefficient of 87.23%, outperformed U-Net and its variants for left ventricular segmentation in TSV TEE, particularly in challenging cases. The model parameter size of Echo-EU-Net was 1.30 million, compared with 7.79 million for U-Net. The proposed EF prediction method had a satisfying agreement with the manual EF measurements (Pearson's r=0.84), with a mean absolute error of 6.44%. An ablation study demonstrated the effectiveness of the MECA and EASPP modules. CONCLUSION:The feasibility of the proposed Echo-EU-Net-based method in automatically segmenting the left ventricle and measuring EF in TSV TEE has been demonstrated. The findings of this study may shed light on lightweight deep learning-based fully automated left ventricular segmentation and EF quantification in TSV TEE.

INTRODUCTION:Multiple electrolyte imbalances (MEIs) are underexplored in hospitalized patients. We aimed to determine: (1) the prevalence and prognostic impact of MEIs; (2) the associations between electrolyte imbalance (EI) combinations and adverse outcomes; and (3) the potential interactions among EI types. MATERIALS AND METHODS:Hospitalized patients at Peking Union Medical College Hospital were enrolled from 2015 to 2020. Adverse outcomes included in-hospital mortality or discharge against medical advice. Multivariable logistic regression models were used to evaluate the associations of number of EIs, EI types, and their combinations with adverse outcomes and to calculate the population-attributable fractions (PAFs). The additive and multiplicative interactions were examined for each EI combination. RESULTS:Among 324,056 hospitalizations, the prevalence of MEIs was 18.8%. Compared to patients without EIs, the odds ratios (ORs) for adverse outcomes were 2.18 (95% confidence interval [CI]: 1.83-2.59) for patients with 1 EI and 17.34 (95% CI: 15.32-19.62) for those with ≥2 EIs. The highest-risk EI combinations at the individual level were hypercalcemia-hypernatremia (OR = 14.96 [95% CI: 11.34-19.68]), hyponatremia-hypernatremia (13.00 [95% CI: 10.09-16.74]), and hypochloremia-hypernatremia (11.06 [95% CI: 8.51-14.34]), while hypokalemia-hypernatremia (PAF = 17.89% [95% CI: 17.37%-18.41%]), hyperchloremia-hypernatremia (15.29% [95% CI: 14.99%-15.59%]), and hypocalcemia-hypernatremia (12.40% [95% CI: 11.94%-12.86%]) contributed the most to adverse outcomes at the population level. Synergistic additive interactions were observed for hyperchloremia-hypernatremia (relative excess risk due to interaction = 4.80 [95% CI: 3.05-6.55]) and hypercalcemia-hypernatremia (6.98 [95% CI: 3.11-10.86]). CONCLUSIONS:MEIs are common and harmful in hospitalized patients. Prioritizing different intervention targets at individual and population levels may improve clinical outcomes.

Introduction Recurrence of acute pancreatitis (AP) is common, leading to cumulative pancreatic injury and reduced quality of life. While aetiology-based treatments and lifestyle interventions are effective, long-term adherence is often poor due to insufficient health awareness and a lack of continuous reminders. We designed the PROGRESS (PROactive GRadEd follow-up Strategy for reducing recurrence in acute pancreatitiS) trial to evaluate whether a physician-initiated, proactive and graded follow-up strategy can reduce AP recurrence.Methods and analysis The PROGRESS trial is a multicentre, open-label, randomised controlled trial. A total of 194 patients with AP will be randomised 1:1 to either a proactive follow-up group or a standard follow-up group. In the proactive follow-up group, patients are stratified into high-risk or low-risk categories based on reported risk factors. Follow-up is conducted via WeChat with varying frequencies: every 3 months for the high-risk group and every 6 months for the low-risk group. The standard follow-up group receives routine discharge education and a 1-month outpatient visit. The primary endpoint is the number of AP recurrence episodes within 24 months post-discharge. Secondary endpoints include AP recurrence rate, progression to chronic pancreatitis, quality of life (Short Form 12 Health Survey), anxiety/depression scores (Generalized Anxiety Disorder-7/Patient Health Questionnaire-9), readmission rates and mortality. Analysis will follow the intention-to-treat principle.Ethics and dissemination This study has been approved by the Ethics Committee of Peking Union Medical College Hospital (No. I-25PJ2556, I-26PJ0895). Ethics approval of each participating centre is required before initiation of patient enrolment. The results of this study will be published in peer-reviewed journals.Trial registration number ChiCTR2500113459 (Chinese Clinical Trial Registry).

Lung cancer remains the leading cause of cancer-related mortality worldwide, with stage at diagnosis significantly influencing survival outcomes. This systematic review evaluates global variations in lung cancer stage distribution at diagnosis and examines the associations of socioeconomic factors and screening programs with these disparities. We conducted a systematic review following PRISMA guidelines, searching PubMed, Embase, and grey literature up to August 14, 2024, to identify population- or hospital-based cancer registry data on lung cancer staging. Data from 36 countries were analyzed, focusing on the proportion of distant metastatic cases. We assessed associations with Human Development Index (HDI) and Socio-Demographic Index (SDI) using case-number-weighted linear regression model and evaluated time trends in countries with and without screening programs. Subgroup analyses explored variations by sex, age, and tumor type. Among the 35 countries analyzed in the main study, the median proportion of lung cancer cases diagnosed with distant metastasis was 50.8

Background:Patients with rheumatic diseases are at high risk for latent tuberculosis infection (LTBI) reactivation. We aimed to evaluate whether a modified 3-month regimen (3HP-PUMCH) was non-inferior to the standard 9-month isoniazid regimen (9H) for tuberculosis preventive treatment in this vulnerable population. Methods:We conducted a multicenter, open-label, randomized, non-inferiority trial at nine tertiary general hospitals in China. Eligible participants were adults (18-70 years) with high-risk rheumatic diseases and LTBI undergoing immunosuppressive therapy. Patients were randomized (1:1) to receive either the 3HP-PUMCH regimen (twice-weekly rifapentine 450 mg plus daily isoniazid 300 mg) or the 9H regimen (daily isoniazid 300 mg). The primary endpoint was the occurrence of tuberculosis, with a non-inferiority margin of 1.4 percentage points. Analysis used the modified intention-to-treat population. The trial was registered with Chinese Clinical Trial Registry ChiCTR1800018242. Findings:Between 19 September 2018 and 18 August 2021, 536 patients with rheumatic diseases were enrolled. The cumulative rate of tuberculosis was 0.00% (0 of 249, 95% CI 0.00-1.47) in the 3HP-PUMCH group, compared with 1.15% (3 of 260, 95% CI 0.24-3.34) in the 9H group, with a rate difference of -1.15 percentage points (95% CI -2.4 to 0.14). Drug discontinuation rates due to serious adverse events or tuberculosis occurrence were 2.8% (7 of 249) in the 3HP-PUMCH group and 1.9% (5 of 260) in the 9H group (p = 0.509). Adverse drug reactions occurred in 24 (9.6%) of 249 patients versus 39 (15.0%) of 260 (p = 0.066), with hepatotoxicity in 11 (4.4%) of 249 versus 27 (10.4%) of 260 (p = 0.010). 223 (89.6%) of 249 patients completed treatment in the 3HP-PUMCH and 237 (91.2%) of 260 in the 9H group (p = 0.54). Interpretation:The short-course 3HP-PUMCH regimen was non-inferior to the 9H regimen in preventing tuberculosis and demonstrated a favorable safety profile, with high treatment completion in LTBI patients with rheumatic diseases. This regimen might be more suitable for patients with underlying diseases and those on concomitant medications. Funding:National Natural Science Foundation of China.

OBJECTIVE:To prospectively evaluate the diagnostic performance of traditional versus optimized adrenocorticotropic hormone (ACTH) ratio cutoffs for desmopressin (DDAVP)-stimulated bilateral inferior petrosal sinus sampling (BIPSS) in differentiating Cushing disease (CD) from ectopic ACTH syndrome (EAS) in ACTH-dependent Cushing syndrome. METHODS:We conducted a prospective single-center observational cohort study of 181 consecutive patients undergoing DDAVP-stimulated BIPSS in a high-volume tertiary pituitary center (Peking Union Medical College Hospital) in China between October 2023 and December 2024. Final diagnosis was confirmed by histopathology and/or biochemical remission. Diagnostic accuracy of traditional cutoffs (basal IPS:P >2.0 or stimulated >3.0) versus optimized cutoffs (determined by receiver operating characteristic curve analysis) was compared. RESULTS:Among 167 patients with definitive diagnosis (153 CD, 14 EAS), BIPSS showed excellent overall discrimination (area under the curve, 0.994). Traditional cutoffs yielded a sensitivity of 91.5% and specificity of 100.0%. Lower cutoffs (basal IPS:P >1.49 or peak stimulated IPS:P >2.26) improved sensitivity to 97.4% while maintaining 100.0% specificity. Most peak IPS: P values occurred at 3 to 5 min post-DDAVP. False-negative results were associated with absent intersinus lateralization and low IPS ACTH levels, suggesting technical or anatomic sampling limitations rather than impaired DDAVP responsiveness. CONCLUSION:DDAVP-stimulated BIPSS showed excellent diagnostic performance for differentiating CD from EAS and provides a practical alternative stimulation strategy when corticotropin-releasing hormone is unavailable. Lower DDAVP-specific ACTH ratio cutoffs improved sensitivity without compromising specificity and may reduce false-negative diagnoses of CD in patients with ACTH-dependent Cushing syndrome.

Prehabilitation is a process for optimizing preoperative functional capacity, yet its implementation efficiency and patient adherence remain challenging. This study aimed to develop a short home-centered multimodal prehabilitation program administered via a digital platform and to preliminarily evaluate changes in preoperative functional capacity and patient adherence among patients scheduled for major elective surgery. This prospective single-arm trial included patients who were candidates for major surgery. A web-based prehabilitation program was established using a cloud-based mobile application to deliver individualized interventions, including medical and lifestyle guidance, aerobic exercise, resistance training, respiratory training, nutritional support, and psychological support. The absolute change in the six-minute walk distance (6MWD) from the initial assessment to the immediate preoperative day was defined as the primary study endpoint. Secondary outcomes included changes in body mass index (BMI); the rate of smoking cessation; grip strength; pulmonary function; the Duke Activity Status Index (DASI); the Nutritional Risk Screening 2002 (NRS-2002); the Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight scale (FRAIL scale); and the Hospital Anxiety and Depression Scale (HADS). Adherence was quantified using backend data from the application. The statistical association between changes in the 6MWD and adherence was tested, and multivariable linear regression was conducted to evaluate the associations between adherence and clinical characteristics. Forty patients were analyzed. Compared with the baseline, the preoperative 6MWD significantly increased (mean difference = 33.36 m, 95

BackgroundThe expansion of plastic and aesthetic industries is heavily market-driven. With socioeconomic advancement, the plastic and aesthetic industries have experienced extraordinarily rapid growth over the past several decades, exhibiting distinct patterns between public and private hospitals.MethodsWe collected national data from public and private hospitals across mainland China through the National Clinical Information System (NCIS) and the National Medical Quality Control Platform (NMQCP) for Plastic and Aesthetic Major. Data encompassed hospital profiles, practitioner demographics, inpatient clinical case mix, ambulatory therapeutic modalities, and the consultation rate for aesthetic injection complications.ResultsAmong public hospitals offering plastic/aesthetic services, 99.20% were general hospitals, while 80.60% of private hospitals were specialized in plastic and aesthetic procedures. We also found significant differences between public and private hospitals regarding physician qualifications, professional backgrounds, inpatient case mix, and ambulatory therapeutic modalities. The consultation rate for aesthetic injection complications was additionally higher in public hospitals relative to private hospitals.ConclusionBoth public and private hospitals have established plastic and aesthetic specialties with distinct scale characteristics. Driven by greater operational autonomy and their market-driven nature, private hospitals exhibited greater flexibility in development within this specialty and demonstrated a stronger preference for minimally invasive treatments. However, despite their perceived minimal invasiveness, aesthetic injections carried significant complication risks; and particularly, severe cases resulted in substantial physical trauma and financial burdens for aesthetic patients. We recommend that government authorities formulate tailored quality-control measures based on the divergent developmental paths of public and private hospitals to safeguard patient safety.Level of Evidence IIIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Abstract Purpose Perioperative metabolic vulnerability is an important contributor to postoperative morbidity, yet preoperative risk stratification relies largely on conventional glycemic measures such as hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG). Hemoglobin glycation index (HGI) quantifies interindividual discordance between HbA1c and contemporaneous glycemia and may capture metabolic phenotypes not reflected by absolute glucose values. We investigated the association between preoperative HGI and postoperative outcomes in adults undergoing non-cardiac surgery. Methods We conducted a retrospective single-center cohort study including adult inpatients who underwent non-cardiac surgery under general anesthesia between January 2013 and June 2024. Patients with both preoperative HbA1c and FPG measured within 60 days before surgery were included. HGI was calculated as the residual of observed HbA1c minus HbA1c predicted from FPG using a cohort-specific linear regression model. The primary outcome was any postoperative complication occurring before hospital discharge. Secondary outcomes included major complications (Clavien–Dindo grade ≥ III), organ-specific complications, deep-vein thrombosis, Intensive Care Unit (ICU) admission, hospital and postoperative length of stay, and in-hospital mortality. Associations were evaluated using multivariable regression models with HGI analyzed as a continuous variable (per 1–SD increase) and by quartiles (Q2 as reference), complemented by restricted cubic spline analyses and prespecified subgroup analyses. Results A total of 24,307 patients were included (mean age 58.8 ± 13.3 years; 51% women). Postoperative complications occurred in 8.4% of patients. In adjusted continuous models, higher HGI was independently associated with postoperative complications (odds ratio [OR] per 1–SD increase 1.068; 95% confidence interval [CI], 1.018–1.120; P = 0.007), urinary complications (OR 1.155; 95% CI, 1.024–1.301; P = 0.018), and longer total hospital length of stay (adjusted mean ratio 1.030; 95% CI, 1.017–1.043; P = 0.001). Quartile analyses demonstrated the lowest risk of postoperative complications in the mid-range HGI group, with higher risks observed at extreme HGI values. Restricted cubic spline models revealed an approximately linear association between HGI and overall postoperative complications, while outcome-specific nonlinear relationships were observed for major complications, ICU admission, and in-hospital mortality. Associations were generally consistent across subgroups, with no statistically significant interaction detected across prespecified strata. Conclusions Preoperative hemoglobin glycation index was independently associated with postoperative complications after non-cardiac surgery and identified nonlinear risk patterns for selected severe outcomes. HGI may serve as a complementary perioperative metabolic risk marker beyond HbA1c and fasting plasma glucose to provide incremental risk information.

Background Fertility decline and delayed childbearing may influence women’s long-term cancer risk. Objectives To quantify associations of parous status, parity and age at first birth with incident female cancers and assess dose-response/non-linearity. Search strategy PubMed and Embase were searched from inception to 18 Nov 2024. Selection criteria Cohort and case–control studies in adult women reporting parous status, parity or age at first birth in relation to incident cancer. Data collection and analysis Cancers were harmonized using WHO Global Health Estimates 2021. Random-effects meta-analysis and prespecified linear/quadratic/spline dose–response models were used with AIC-guided selection. Main results We included 123 studies (~18.75 million women) across 17 cancer sites and seven tumors’ subtypes. Ever-parous versus nulliparous women had lower breast cancer risk (ES 0.79, 95% CI 0.67–0.91). Each additional birth was associated with lower risks of breast (7% per birth), ovarian (14%), endometrial (29%) and lung cancers (21%). Each one-year increase in age at first birth was associated with higher risks of breast cancer (3% per year) and melanoma/skin cancer (2.5% per year). U-shaped associations were observed for endometrial and thyroid cancers. Subtype analyses suggested reduced epithelial ovarian cancer risk and increased triple-negative breast cancer risk among parous women. Conclusions Reproductive history shows heterogeneous, site- and subtype-specific associations with cancer risk; parity appears protective for several cancers, whereas delayed childbearing may increase breast and skin cancer risk.

BackgroundOptimizing intravascular volume (IV) before surgery is crucial for patients undergoing resection of functioning pheochromocytomas and paragangliomas (PPGLs). While point-of-care ultrasound (POCU) is a noninvasive technique to assess IV, the use of POCU to evaluate preoperative IV and its relationship to perioperative adverse outcomes (PAOs) remains largely unexplored.MethodsWe conducted a prospective cohort study including patients who underwent PPGL resection following preoperative α-blockade. Preoperative IV was assessed using inferior vena cava (IVC) ultrasound and clinical parameters. We used logistic regression models to examine the associations between preoperative IV and intraoperative hemodynamic instability (IHI), perioperative organ dysfunction (POD), and PAO. We also compared the predicting abilities of IVC ultrasound measurements and clinical parameters for PAOs.ResultsA total of 80 patients were recruited and analyzed. The study population carried a heavy comorbidity burden (median age-adjusted Charlson Comorbidity Index 4), thus the median duration of preoperative α-blockade was 60 (30, 98) days. Based on IVC ultrasound, 27 patients were classified as having appropriate volume status and 53 as inappropriate volume status. We found no significant association between IVC ultrasound assessed IV status and IHI, POD, and PAO. Furthermore, neither IVC ultrasound assessments nor clinical parameters could discriminate PAOs, and the predictive performance of the two methods did not differ significantly. However, this finding should be interpreted with caution, as the study was likely to be underpowered (enrolled 80 of 364 planned patients, 22%).ConclusionIn this study with a sample size of 80 patients, no independent association was found between preoperative IVC ultrasound measurements and PAOs in patients undergoing PPGL resection with an extended duration of preoperative α-blockade preparation [60 (30, 98) days]. The utility of point-of-care IVC ultrasound in guiding preoperative volume optimization for these patients merits further exploration.

OBJECTIVES:Scoliosis is a prevalent spinal deformity that severely impacts the physical and psychological well-being of adolescents and often requires surgical correction. This study aimed to investigate the risk factors for postoperative pulmonary complications (PPCs) following posterior spinal fusion in adolescent scoliosis, with a specific focus on evaluating the predictive value of preoperative forced vital capacity (FVC) and etiological classification. METHODS:This retrospective cohort study enrolled adolescents who underwent posterior spinal fusion for scoliosis correction at Peking Union Medical College Hospital between January 2018 and December 2022. The baseline demographic, clinical, and perioperative variables were collected. The primary endpoint was the occurrence of PPCs prior to hospital discharge. Univariate and multivariable binary logistic regression analyses were conducted to identify independent risk factors. RESULTS:A total of 1,234 patients were included, of whom 29 (2.35%) developed PPCs and 1,205 did not. Univariate analysis revealed that 12 variables, including non-idiopathic scoliosis, a larger main thoracic curve, a decreased FVC% predicted, and increased perioperative blood transfusions, were significantly associated with PPCs (P < 0.05). Multivariable logistic regression model showed that non-idiopathic scoliosis emerged as the sole independent risk factor for PPCs [adjusted odds ratio (OR) = 5.478, 95% confidence interval: 2.017-19.148, P = 0.002]. Preoperative FVC% predicted (adjusted OR = 0.993, P = 0.497) and main thoracic curve (adjusted OR = 1.002, P = 0.736) did not demonstrate independent predictive value. CONCLUSIONS:Non-idiopathic scoliosis, rather than preoperative pulmonary function or curve severity, is an independent risk factor for PPCs following posterior spinal fusion in adolescents. During perioperative respiratory risk assessment, particular emphasis should be placed on the etiological classification of these patients.

Background:Postoperative atrial fibrillation (POAF) is among the most frequent complications after video-assisted thoracoscopic surgery (VATS). Although there are numerous risk prediction models and advanced age is a notable factor, only a handful of these models specifically address older, high-risk groups. This study therefore aimed to construct a POAF risk model for patients aged 65 years and older undergoing VATS to support precise perioperative monitoring and preventive measures. Methods:We conducted a retrospective analysis of 4,449 eligible patients aged ≥65 years who underwent VATS at Peking Union Medical College Hospital from January 2013 to March 2024. The data were split into a training cohort (n=2,918) and a testing cohort (n=1,531) using a cutoff date of January 1, 2022. POAF was defined as follows: (I) any recorded atrial fibrillation episode lasting at least 6 minutes; (II) no history of atrial fibrillation (AF) prior to surgery; and (III) onset within 30 days postoperatively. Variables with a univariable P<0.20 and those deemed clinically important from prior literature were included in the multivariable logistic regression to identify predictors of POAF. Internal validation was performed within the training cohort. Discrimination was measured by the area under the receiver operating characteristic curve (AUROC), while calibration was assessed with the Hosmer-Lemeshow test and calibration plots. Overall predictive accuracy was summarized by the Brier score. Results:POAF occurred in 4.2% of patients (187/4,449). Five predictors were ultimately incorporated into the final model and depicted as a nomogram: male sex, elevated N-terminal pro-brain natriuretic peptide (NT-proBNP), enlarged left atrial anteroposterior diameter, lobectomy, and left-sided tumor location. In the training cohort, the model achieved an AUROC of 0.718 [95% confidence interval (CI): 0.675-0.764], with a sensitivity of 80.5% and a specificity of 48.5%. In the testing cohort, the AUROC was 0.753 (95% CI: 0.671-0.835), with a sensitivity of 86.1% and a specificity of 54.4%. Calibration was satisfactory, as indicated by Hosmer-Lemeshow P values above 0.05 in both groups. The Brier scores were 0.025 (training) and 0.021 (testing). Conclusions:We identified five readily obtainable clinical predictors and integrated them into a nomogram that demonstrated good discrimination and calibration for predicting POAF in patients aged65 years and older who underwent VATS. This practical tool supports perioperative risk stratification and could inform targeted prevention and monitoring strategies in high-risk surgical populations.

BACKGROUND:Serum albumin plays an important role in maintaining colloid osmotic pressure and fluid balance. Hypoalbuminemia has been identified as a predictor of postoperative mortality and morbidity. However, the impact of preoperative hypoalbuminemia on intraoperative red blood cell (RBC) transfusion has seldom been investigated. MATERIAL AND METHODS:This was a single-center retrospective cohort study conducted at a general tertiary teaching hospital in Beijing. The study included adult patients who underwent representative elective major surgeries between 2018 and 2022. The exposure was preoperative hypoalbuminemia, defined as a serum albumin concentration of less than 35 g/l. The primary outcome was the transfusion of allogeneic RBCs during surgery or within three days postoperatively. Twenty confounders related to demographic characteristics, comorbidities, and procedural complexity were adjusted for using multivariable logistic regression and inverse probability of treatment weighting (IPTW). Dose-response analysis, subgroup analysis based on preoperative hemoglobin levels, and mediation analysis of intraoperative blood loss were also performed. RESULTS:A total of 15 336 patients were included, of whom 678 (4.4%) had preoperative hypoalbuminemia. Perioperative RBC transfusions were administered to 1804 patients (11.8%). A significant association between preoperative hypoalbuminemia and the risk of perioperative RBC transfusion was observed when adjusting for confounders using logistic regression [odds ratio (OR): 2.04, 95% confidence interval (CI): 1.65-2.54, P < 0.001] or IPTW (OR: 1.89, 95% CI: 1.47-2.44, P < 0.001). This association became stronger as albumin level decreased (P for trend <0.001), remained significant across preoperative hemoglobin levels, and was mediated by increased intraoperative blood loss (proportion of mediation 22.7%, 95% CI: 10.5-37.4%, P < 0.001). CONCLUSIONS:Preoperative hypoalbuminemia was associated with an increased risk of perioperative RBC transfusion. These findings highlighted the importance of preparing for RBC transfusion and implementing blood conservation strategies in patients with hypoalbuminemia.

Purpose:To meet the rapidly growing demand for digestive endoscopies and daytime surgeries, the setup of preoperative assessment clinics is increasing explosively in China. This study aims to explore patient attitudes to patient education and to assess patient awareness scores regarding informed consent and perioperative instructions in preoperative anesthesia clinic, as well as to evaluate the preference of current patient education tools. Patients and Methods:A cross-sectional study was conducted across five hospitals. A 37-item digital questionnaire was administered to patients who attended preoperative anesthesia assessment clinics and underwent digestive endoscopies between September 1 and September 20, 2024. Awareness scores were calculated as the sum of correct responses to 15 questions assessing perioperative knowledge, with a total score ranging from 0 to 15, and higher scores indicating greater awareness. Results:A total of 1300 participants were included in the study. Over 97% of the patients reported a positive attitude to the preoperative assessment clinic. Approximately 20% of patients reported poor recall of the information provided by anesthesiologists. Mean awareness rates were 51.2% for preoperative precautions, 62.7% for anesthesia-related risks, and 56.7% for postoperative precautions, with an overall awareness score of 8.37 ± 4.2 points. Higher awareness scores correlated with higher education levels (p < 0.05), shorter intervals (≤1 week) between clinic visits and procedures (p < 0.05), and the use of multimedia and interactive educational methods (p < 0.05). Conclusion:Sole reliance on preoperative anesthesia assessment clinics for patient education on informed consent and perioperative instructions is inadequate. We recommend a multimodal, patient-centered approach that accounts for educational background, integrates periodic reinforcement, and employs diverse educational tools, including multimedia and interactive strategies, to optimize information comprehension and retention.

To compare the overall survival (OS) and cancer-specific survival (CSS) of right-sided colon cancer patients undergoing CME versus D2 surgery after 5 years of follow-up, and to assess the heterogeneity of treatment effectiveness of CME between different subgroups. The 3-year result of the Radical Extent of lymphadenectomy of Laparoscopic Right Colectomy for colon cancer (RELARC) trial showed that standard D2 dissection should be performed in right-sided colon cancer patients. In patients with lymph node metastasis, complete mesocolic excision (CME) showed potentially favorable results. The parallel, open label, randomized controlled trial was conducted between January, 2016 to December, 2019 in 17 hospitals in China. Of a total of 1072 eligible patients enrolled, 995 patients were included in the modified intention-to-treat analysis. In the present study, the primary outcome was 5-year OS and the secondary outcome was 5-year CSS. The trial is registered with ClinicalTrials.gov (Identifier: NCT02619942). 995 patients were included in the final analysis. There was no significant difference between the 5-year OS (HR: 0.74, 95%CI: 0.51–1.07, P=0.105) or CSS (HR: 0.72, 95%CI: 0.49–1.06, P=0.091) in the CME and D2 groups. CME appears to improve 5-year outcomes in patients with stage III disease (OS: HR: 0.58, 95% CI: 0.37–0.93, P=0.023; CSS: HR: 0.59, 95% CI: 0.37–0.94, P=0.028), particularly in those with pN2 (OS: HR: 0.25, 95% CI: 0.11–0.57, P=0.001; CSS: HR: 0.25, 95% CI: 0.11–0.57, P=0.001), where a statistically significant interaction was identified. Patients with lymphovascular invasion also demonstrated favorable outcomes with CME with significant interaction effect (OS: HR: 0.34, 95% CI: 0.17–0.70; interaction P=0.009; CSS: HR: 0.32, 95% CI: 0.15–0.67, interaction P=0.008). The standard D2 dissection provides oncologic outcomes comparable to CME on the 5-year follow-up. However, CME seems to improve 5-year outcomes in patients with stage III, particularly those with pN2 status, and may confer benefit in patients with LVI.

The association between intraoperative lactate levels and postoperative prognosis following emergency surgery remains inconclusive. We aimed to investigate the prognostic significance of intraoperative lactate levels in predicting in-hospital mortality. This single-center, retrospective, observational study was conducted at Peking Union Medical College Hospital from 2017 to 2023. Intraoperative peak lactate levels were analyzed using a restricted cubic spline (RCS) model, with in-hospital mortality designated as the primary outcome. Secondary outcomes were length of stay, ICU stay, and ventilation duration. Prespecified subgroup analyses (by ASA grade and surgery type) and a sensitivity analysis excluding in-hospital deaths for secondary endpoints were performed. Among the 2,452 patients included in the study, 161 died postoperatively. Both univariate and multivariate regression analyses demonstrated that the intraoperative peak lactate level was associated with perioperative mortality (odds ratio [OR] 1.306, 95

CONTEXT:Immune checkpoint inhibitor (ICI)-related hypothyroidism is mostly irreversible and prompt thyroid hormone replacement therapy is crucial, especially for patients undergoing neoadjuvant immunotherapy. OBJECTIVE:This study aimed to propose a novel titration strategy for ICI-related hypothyroidism, evaluate levothyroxine (LT4) dose differences between hypothyroidism patterns, and develop a predictive equation for the optimal LT4 dose. DESIGN:Retrospective study. SETTING:Tertiary academic hospital. PATIENTS:A total of 109 patients with ICI-related hypothyroidism. INTERVENTIONS:Rapid vs conventional titration strategy. MAIN OUTCOME MEASURES:The time to achieve normal free thyroxine and TSH levels. RESULTS:Patients with transient thyrotoxicosis followed by overt hypothyroidism required higher LT4 doses to achieve a euthyroid state compared to isolated overt hypothyroidism, with a mean difference of 0.23 μg/kg/day (95% CI, 0.08-0.38). In patients with ICI-related overt hypothyroidism and no cardiac disease, who had elevated TSH levels within 4 weeks of the last documented low or normal TSH, a rapid titration strategy was implemented. This strategy significantly improved the cumulative incidence of achieving normal free thyroxine and TSH levels compared to conventional titration strategy (hazard ratio, 4.44; 95% CI, 2.24-8.82; and hazard ratio, 4.11; 95% CI, 2.18-7.73, respectively), with a comparable safety profile. Predicted LT4 dose at euthyroid state (µg/kg/day) = (-0.016 × body weight) + (0.109 × baseline TSH level) + 2.661 for patients with thyrotoxicosis followed by overt hypothyroidism. CONCLUSION:LT4 requirements vary depending on the subtype of ICI-related hypothyroidism. The rapid titration strategy reduced the time to achieve a euthyroid state without a significant increase in adverse effects compared to conventional LT4 replacement therapy.