This study examines the prevalence of depression and its determinants among Chinese middle-aged and elderly arthritis patients, aiming to establish a theoretical foundation for enhancing their mental well-being and to inform the development of targeted prevention and intervention strategies. Data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) were used for this study. We defined depression status in middle-aged and elderly arthritis patients as the dependent variable and included 16 predictor variables. The data were randomly divided into training and validation sets according to 7:3 ratio. LASSO and binary logistic regression analyses were performed on the training set to screen predictor variables and construct the model, which was then internally validated on the validation set. This study included 1302 middle-aged and elderly arthritis patients. LASSO and binary logistic regression analysis were used to construct a prediction model for depression applicable to this population in China. The nomogram analysis revealed that female sex, middle age (45–59 years), poor self-rated health, being troubled by body pain, low life satisfaction, low marital satisfaction, low child satisfaction, and difficulties with instrumental activities of daily living (IADL) were risk factors for depression (P < 0.05). The area under the receiver operating characteristic curve(ROC) exceeded 0.70 in both the model training and internal validation phases, demonstrating the model’s high accuracy in predicting depression risk. In addition, decision curve analysis (DCA) and calibration curve analysis further confirmed the model’s practical value and validity. In this study, we identified that being female, middle-aged, having poor self-rated health, being troubled by body pain, dissatisfaction with life, marriage, and children, and difficulties with instrumental activities of daily living were risk factors for depression among middle-aged and elderly arthritis patients. We developed a predictive model based on these risk factors to facilitate early identification, intervention, and treatment for high-risk individuals.

Background: Postoperative pulmonary complications (PPCs) are common among patients undergoing abdominal surgery. Despite the benefit of lung-protective ventilation strategy to prevent PPCs, the optimal inspiratory oxygen fraction (FiO2) and the role of recruitment maneuvers (RMs) in the strategy remains controversial. This trial aims to evaluate the effects of different FiO2 levels and RMs on the incidence of pulmonary complications following abdominal surgery. Methods: This is a multi-center, 2×2 factorial, randomized, controlled trial involving 1536 patients at intermediate to high risk of PPCs undergoing major abdominal surgery. Participants will be randomly assigned (1:1:1:1) to receive lung-protective ventilation with either 80% FiO2 or the lowest FiO2 required to maintain SpO2 ≥ 94%, with or without standardized RMs. All patients will follow an enhanced recovery after surgery protocol. The primary outcome is the incidence of pulmonary complications within the first 7 postoperative days, including respiratory infection, respiratory failure, atelectasis, and clinically significant pleural effusion. Secondary outcomes include the severity grade of PPCs, incidence of PPCs within 30 days, and other clinical endpoints. Discussion: The use of conservative FiO2 or standardized RMs within a lung-protective ventilation strategy is anticipated to reduce pulmonary comlications in at-risk patients. The trial’s design, enrollment strategy, and outcome measures are expected to yield clinically relevant results and contribute to optimizing perioperative mechanical ventilation. Trial registration: Chinese Clinical Trial Registry ChiCTR2400092953. Prospectively registered on 26 November 2024.

Inadvertent intraoperative hypothermia (IOH) significantly increases the risk of complications in elderly patients undergoing general anesthesia. This study aimed to develop and validate a predictive model for IOH specifically for elderly patients in Southwest China. A total of 443 patients aged >= 60 years from 24 hospitals were enrolled and randomly assigned to a derivation cohort (n = 310) and an internal validation cohort (n = 133). Logistic regression, LASSO regression, and random forest models were developed, with internal validation used to select the optimal approach. External validation was performed on 334 patients from 4 participating and 4 non-participating hospitals. In the internal validation, the Logistic Regression model outperformed machine learning algorithms, demonstrating an area under the receiver operating characteristic curve (AUC) of 0.841 (95% CI: 0.772-0.910), with a specificity of 81.48%, sensitivity of 70.21%, and optimal risk threshold of 48%. In the external validation cohort (n = 334), the model maintained robust discriminative ability (AUC: 0.760; 95% CI: 0.703-0.817). Crucially, in a subgroup analysis of patients with normal temperature (>= 36.5 degrees C) at 10 min before anesthesia induction, the model successfully identified 34 high-risk individuals who would likely be overlooked by standard clinical assessment. The Logistic Regression model effectively predicts IOH risk in elderly patients, and a risk probability >= 48% serves as a critical threshold to guide stratified temperature management.

To investigate the mechanisms behind the worsening of acute lung injury (ALI) in obesity, transcriptomic sequencing is performed, and significantly reduced mRNA levels of Aconitate Decarboxylase 1 (ACOD1) in the lung tissue of high-fat diet (HFD) mice are found. Clinical samples are collected, an ALI model is established in HFD mice, and both human and mouse samples are analyzed, revealing a significant decrease in ACOD1 expression in lung tissue and alveolar macrophages in obesity. Further in vivo and in vitro experiments show that ACOD1 knockdown worsens lung injury, inflammation, and oxidative stress, while ACOD1 overexpression alleviates these effects. Moreover, nuclear factor erythroid 2-related factor 2 (Nrf2) inhibition diminishes the protective effects of ACOD1 overexpression in ALI exacerbated by obesity. Additionally, in the context of obesity, growth factor independent 1 (GFI1) protein levels are elevated in alveolar macrophages, and its knockdown leads to upregulated ACOD1 expression. Therefore, this study suggests that ACOD1 downregulation in alveolar macrophages is a key factor in worsening ALI in obesity, likely driven by GFI1 upregulation.

BACKGROUND:Intraoperative hypothermia is associated with adverse maternal and neonatal outcomes. However, the relationship between obesity and intraoperative hypothermia remains contentious. The aim of this study was to investigate the association between obesity and intraoperative hypothermia in women undergoing caesarean delivery. MATERIALS AND METHODS:We prospectively recruited 705 women who underwent caesarean delivery. Patients were classified into two groups according to body mass index (BMI): non-obese group (BMI < 28 kg/m2) and obese group (BMI ≥ 28.0 kg/m2). The primary outcome measure was the incidence of intraoperative hypothermia, defined as a core temperature of less than 36°C. Intraoperative core temperature was measured in the bladder. Propensity score-matched analyses, multivariable logistic regression analyses, subgroup analyses, and restricted cubic splines were used to assess the association between obesity and intraoperative hypothermia. RESULTS:After propensity score matching, 244 matched pairs were selected for analysis. Participants in the obese group exhibited a significantly lower incidence of hypothermia compared to those in the non-obese group (27.5% vs. 38.9%; P < 0.01). The incidence of need for rescue warming was lower in the obese group compared to the non-obese group (1.2% vs. 5.3%; P = 0.01). Similar findings were observed in the overall study population, the obese group was associated with a significantly decreased incidence of hypothermia when compared to the non-obese group (OR, 0.59; 95% CI, 0.41-0.83; P = 0.03). There was a non-linear association between BMI and hypothermia, with the lowest risk at a BMI of 28.4 kg.m-2. CONCLUSIONS:Obesity was associated with a potentially lower risk and severity of intraoperative hypothermia compared with non-obese patients. Although a non-linear relationship between the degree of obesity and hypothermia was observed, the clinical significance of more severe obesity on hypothermia risk remains to be clarified.

Background:Chronic postsurgical pain (CPSP) after video-assisted thoracic surgery (VATS) has been a focus for research and clinical improvement for decades. However, large-scale epidemiological reports from prospective studies are still lacking. The goal of this study was to present the CPSP profiles after VATS from a nationwide survey. Methods:Patients who were scheduled for VATS at the participating centres were prospectively enrolled in this multicentre observational study between August 1st and September 30th, 2022. Comprehensive assessments of demographic, pain, clinical, and psychological factors were performed before surgery. During surgery, surgical factors, drainage tubes and anaesthesiologic factors were recorded. Postoperative pain was assessed via NRS (Numeric Rating Scale), BPI-9 (Brief Pain Inventory 9 questions) and DN-4 (Douleur Neuropathique 4 questions, as Neuropathic pain four questions in English) interviews on postoperative days 1-3, at discharge, and 3 and 6 months after surgery. Phone interviews were performed at 3- and 6-month follow-ups. Results:A total of 904 patients were recruited, 882 of whom completed the 6-month follow-up and were analysed for CPSP. The incidence rates of CPSP 3 and 6 months after VATS were 38.3% [95% confidence interval (CI): 35.2-41.6%] and 26.8% (95% CI: 23.9-29.8%), respectively, with 10.7% and 4.7% of the cohort (94 and 41 of the 882 patients, respectively) reporting moderate to severe pain (NRS ≥3), respectively. In contrast to previous results for thoracotomy, only 0.5% of the patients complained of neuropathic pain in this study. Acute postoperative pain was significantly related to the incidence of CPSP. Conclusions:CPSP is still a common problem after thoracic surgery (6-month incidence of 26.8%). However, the characteristics of pain may have changed as the surgery becomes less invasive.

BackgroundPost-induction hypotension is a common complications in surgical patients under general anesthesia. Previous evidence indicated preoperative fluid bolus infusion might improve hemodynamic stability after anesthesia induction. But the reported results regarding the postoperative clinical outcomes remains controversary.MethodsColloids infusion for Optimal outcomes In Non-cardiac surgery (COIN) trial is a multicenter, double-blinded, parallel-group, randomized controlled trial being conducted in seven tertiary hospitals in China. The trial will enroll and randomize 2,020 adult participants scheduled to undergo noncardiac surgery under general anesthesia with tracheal intubation. Participants will receive either 5 ml/kg of 6% hydroxyethyl starch 130/0.4 electrolyte solution (colloid group) or balanced multiple electrolyte solution (crystalloid group) prior to anesthesia induction. The primary endpoint is the incidence of postoperative complications within 30 days after surgery, defined as Clavien-Dindo classification Grade I or higher (any deviation from the normal postoperative course, including those requiring pharmacological treatment). The primary analysis will be an unadjusted, modified intention-to-treat comparison between patients randomized to colloids group and crystalloids group using chi-square test. The first patient was enrolled on July 12, 2023, and the trial is expected to be completed in June 2025.ConclusionThe study aims to provide evidence-based insights into reducing postoperative complications in non-cardiac surgery patients undergoing general anesthesia, by comparing the effects of preoperative colloid versus crystalloid solution infusion prior to anesthetic induction. Should the findings demonstrate that colloid solution infusion effectively reduces the 30-day postoperative complication rate, this protocol may contribute to an optimized perioperative management strategy and further promote the clinical adoption of standardized preoperative hemodynamic management.Trial registrationThis study was registered at ClinicalTrials.gov under the identifier NCT05728645 on July 9, 2023, prior to its initiation (http://clinicaltrials.gov).

Background Postoperative hypotension is a common symptom in elderly patients undergoing total knee arthroplasty (TKA), which is associated with intraoperative blood pressure (BP) management. The study aimed to explore the causes of perioperative hypotension in TKA elderly patients and analyze the effects of BP management strategies based on non-invasive heart function monitoring on reducing postoperative hypotension. Methods A total of 176 elderly TKA patients were divided into four groups: the tourniquet group (Group T), the non-tourniquet group (Group N), the goal-oriented BP management tourniquet group (Group GT), and the goal-oriented BP management non-tourniquet group (Group GN). Patients in Groups T and GT received TKA with a tourniquet. The BP of patients in Groups GT and GN was maintained based on non-invasive heart function monitoring. The mean arterial pressure (MAP), index of cardiac contractility (ICON), stroke volume (SV), and other circulatory indicators were measured using the non-invasive cardiometer monitor at five time points, including before anesthesia (T1), after anesthesia (T2), after completion of the osteotomy (T3), after suturing (T4), and after leaving the post-anesthesia care unit (T5). The frequency of postoperative hypotension within 24 hours was recorded, and the incidence of hypotension was calculated. Results The ICON, SV, and MAP were lower in Groups N and GN than in Groups T and GT at T3 (P < 0.05). The ICON, SV, and MAP were lower in Group N than in Groups GN at T4 and T5 (P < 0.05), and no significant difference was observed between Groups T and GT (P > 0.05). The incidence of postoperative hypotension within 24 hours was higher in Group N (47.1%) (P = 0.007) than in Group GN (21.6%), Group T (19.4%), and Group GT (14.8%). Conclusions Postoperative hypotension in elderly patients undergoing TKA with a non-tourniquet was associated with decreased myocardial contractility. Enhancing myocardial contractility based on non-invasive cardiac function monitoring reduced the incidence of postoperative hypotension.

Total intravenous anaesthesia (TIVA) has been widely used for general anaesthesia in clinical practice. In order to further promote the standardised application of TIVA in China, the Chinese Society of Anesthesiology of the Chinese Medical Association organised experts to formulate these clinical practice guidelines for TIVA. After collection and selection of clinical questions, the working group conducted rigorous searches of the literature, formulated recommendations, and reached a consensus. A total of 22 recommendations were made on 12 clinical issues, including the indications, contraindications, and advantages of TIVA, use of depth of anaesthesia monitoring during implementation, pharmacological characteristics of available i.v. anaesthetic drugs, selection and use of drugs in target- and nontarget-controlled infusion modes, and precautions for application of TIVA in special populations, thus providing guidance for anaesthetists to standardise implementation of TIVA.

BACKGROUND:Optimizing analgesia following caesarean section is essential for improving maternal rehabilitation and fostering maternal-infant bonding. OBJECTIVE:The purpose of this study was to evaluate the safety and effectiveness of transcutaneous electrical acupoint stimulation (TEAS) combined with press needle therapy as an adjunctive approach for postoperative pain control following caesarean section. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS:One hundred women with singleton term pregnancies who were schedule to undergo caesarean section births under combined spinal-epidural anesthesia were recruited. Patients were randomly assigned to the acupuncture group (n = 50) or sham-acupuncture group (n = 50). The acupuncture group received pre- and intraoperative TEAS combined with postoperative press needle therapy. The sham-acupuncture group received a sham acupuncture intervention. MAIN OUTCOME MEASURES:The primary outcome was total cumulative morphine consumption at 48 h. Secondary outcomes included pain scores, morphine consumption and patient satisfaction. Analgesic-related adverse effects and acupuncture-related side effects were recorded. RESULTS:Overall, 100 patients were included in the intention-to-treat analysis. Median (interquartile range) of cumulative morphine consumption at 48 h in the acupuncture group was lower than that in the sham-acupuncture group (22.9 [16.9-28.9] mg vs 34.9 [22.4-39.4] mg), with an estimated median difference of -10.0 mg (95% confidence interval, [-14.0, -4.0]; P < 0.001). The generalized estimating equation analysis also revealed that cumulative morphine consumption was significantly lower in the acupuncture group than in the sham-acupuncture group at 6, 12 and 24 h (P < 0.001). In addition, patients in the acupuncture group reported lower pain scores both at rest and during movement at 6, 12 and 24 h compared to those in the sham-acupuncture group (P < 0.001). Furthermore, acupuncture improved patient satisfaction (P < 0.001) and decreased the incidence of nausea and vomiting after surgery (12% vs 30%; P = 0.03). None of the patients in the study experienced any acupuncture-related side effects. CONCLUSION:As a non-pharmacological approach, TEAS combined with press needle therapy safely and effectively reduced postoperative morphine consumption and alleviated postoperative pain in women who underwent caesarean sections, recommending it as a routine complementary treatment for postpartum analgesia. TRIAL REGISTRATION:The protocol was registered at the Chinese Clinical Trial Registry (ChiCTR2400086645). Please cite this article as: Qin PP, Wei K, Zou BY, Liu D, Li MX, Liu XN, Zou L, Wu B. Effectiveness of transcutaneous electrical acupoint stimulation combined with press needle therapy for pain control after caesarean section: A randomized controlled trial. J Integr Med. 2026; 24(4):542-548.

Obesity is an independent risk factor for acute respiratory distress syndrome (ARDS). However, the precise pathway through which obesity amplifies the severity of ARDS remains elusive. Our study embarked on a comprehensive analysis focusing on alterations in the proteomic and metabolomic landscapes of lung tissue extracted from high-fat diet (HFD) mice afflicted with lipopolysaccharide-induced lung injury. This approach was designed to shed light on the molecular mechanisms underlying the exacerbated pulmonary response in obesity-related ARDS. Bioinformatics analysis revealed that dysregulation of sphingolipid metabolism may be involved in the exacerbation of lung injury associated with obesity. Specifically, pulmonary ceramide transfer protein (CERT) expressions were reduced in patients with obesity and HFD mice, while Cer levels were increased. Similarly, co-culture with 3T3-L1 cells reduced CERT expression and increased ceramide (Cer) levels in MH-S cells. Furthermore, overexpression of CERT in vivo and in vitro enhanced Cer transport, leading to reduced Cer levels and, subsequently, a decrease in reactive oxygen species (ROS) production and inflammatory damage in mouse lung tissues and alveolar macrophages. Conversely, CERT knockdown yielded the opposite effect. Moreover, exogenous ceramide supplementation reversed these protective effects conferred by CERT overexpression. In vivo and in vitro studies indicated that obesity-induced downregulation of CERT reduced Cer transport, increased Cer levels, and aggravated ARDS through elevated ROS production and apoptosis. Taken together, these results highlight CERT may represent a promising therapeutic target for managing ARDS in individuals with obesity.

Effective postoperative analgesia is essential for recovery after bariatric surgery. This study examines whether T9 erector spinae plane (ESP) block provides better analgesia and recovery than subcostal transversus abdominis plane (TAP) block in patients with obesity undergoing laparoscopic sleeve gastrectomy (LSG). Patients undergoing LSG were randomized to receive either ESP or TAP blocks. The primary outcome was pain intensity measured by the Numeric Rating Scale (NRS). Secondary outcomes included sensory blockade levels, opioid consumption (morphine equivalents), need for rescue analgesia, and recovery milestones. Among 168 patients, median age was 29.0 years (ESP) vs 31.0 years (TAP) (p = 0.135), with most being female (67.9

Ginsenoside Rh2 (Rh2), an important phytochemical derived from Panax ginseng, has demonstrated anticancer activity, amelioration of ischemic brain injury, and mitigation of doxorubicin-induced cardiac damage. The cardioprotective effects of Rh2 were evaluated in a mouse model of acute myocardial infarction (AMI). Mice received Rh2 treatment for 14 days postsurgery, and the cardiac function was assessed by echocardiography. Rh2 treatment significantly improved left ventricular function, reduced infarct size, and suppressed cardiac fibrosis in the MI model. Furthermore, it promoted angiogenesis in the border zone, enhanced mitochondrial membrane potential and ATP production, and reduced hypoxia-induced ROS accumulation, excessive mitochondrial fission, and cardiomyocyte apoptosis. In vitro, Rh2 enhanced human umbilical vein endothelial cell (HUVEC) migration in wound-healing assays, an effect associated with an increased level of ERK phosphorylation. These effects were abolished by U0126, an ERK inhibitor. In conclusion, Rh2 protects against MI-induced cardiac injury by improving mitochondrial bioenergetics and activating an ERK-dependent pathway.

Background:Laparoscopic renal cyst decompression (LRCD) is a common procedure in urology, but postoperative pain remains a significant challenge. While regional nerve blocks provide more targeted pain relief, there is no universally accepted pain management strategy for LRCD. The ultrasound-guided modified thoracoabdominal nerve block (M-TAPA) may offer effective analgesia by blocking the anterior and lateral branches of the intercostal nerves (T5-T12). However, its efficacy in LRCD has not been thoroughly evaluated. Objective:This study aimed to assess the efficacy and safety of unilateral M-TAPA in reducing postoperative pain and opioid consumption in patients undergoing LRCD, and to evaluate its potential benefits in enhancing recovery. Methods:In this randomized, double-blind, controlled trial, 61 patients undergoing LRCD were assigned to either the M-TAPA group (n = 31) or the Control group (n = 30). The M-TAPA group received ultrasound-guided nerve block, while the Control group received a placebo injection. Postoperative pain was assessed using the numerical rating scale (NRS) over a 48-h period. Additional outcomes included opioid consumption and opioid-related side effects, such as nausea and vomiting. Results:The M-TAPA group had significantly lower NRS scores at all time points compared to the Control group, with the largest difference observed at 6 h postoperatively (4.27 ± 0.83 in the Control group vs. 2.19 ± 0.54 in the M-TAPA group). Repeated measures ANOVA revealed a significant interaction between time and treatment (F = 20.813, p < 0.001). Opioid consumption was reduced by 22% in the M-TAPA group over 48 h (p < 0.001), and the need for antiemetic drugs was significantly lower (p = 0.020). No M-TAPA-related complications were observed. Conclusion:M-TAPA was found to be an effective method for reducing postoperative pain and opioid consumption in patients undergoing LRCD. Clinical Trial Registration:www.chictr.org.cn.

Summary Introduction Conflicting results have been reported regarding the influence of BMI on postoperative adverse events. The aim of this study was to investigate the association between BMI and postoperative pulmonary complications in adults undergoing non‐cardiac, non‐obstetric surgical procedures. Methods This large‐scale retrospective study included 125,082 adults who underwent surgery at a university‐affiliated tertiary care hospital between 2019 and 2023. The primary endpoint was the incidence of postoperative pulmonary complications. Multivariable logistic regression analyses, subgroup analyses, sensitivity analyses and restricted cubic splines were used to assess the association between BMI and postoperative pulmonary complications. Results A total of 6671 patients (5.3%) developed one or more postoperative pulmonary complications. After adjusting for confounders, compared with those patients with a normal weight (BMI 18.5–24.9 kg.m ‐2 ), patients who were underweight (BMI < 18.5 kg.m ‐2 ) had an increased risk of postoperative pulmonary complications (OR 1.24, 95%CI 1.12–1.39, p < 0.001). Patients who were overweight (BMI 25.0–29.9 kg.m ‐2 ) or living with class 1 obesity (BMI 30.0–34.9 kg.m ‐2 ) had a lower risk of postoperative pulmonary complications (OR 0.88, 95%CI 0.83–0.94, p < 0.001 and OR 0.82, 95%CI 0.70–0.96; p = 0.01, respectively). Patients living with obesity class 2/3 (BMI ≥ 35 kg.m ‐2 ) had a similar risk of postoperative pulmonary complications as patients with a normal weight (OR 1.23, 95%CI 0.91–1.66, p = 0.17). There was a J‐shaped association between BMI and incidence of postoperative pulmonary complications with the lowest risk at a BMI of 27.4 kg.m ‐2 . Discussion Patients who were overweight or living with class 1 obesity undergoing non‐cardiac, non‐obstetric surgery had paradoxically lower risks of postoperative pulmonary complications compared with those of a normal weight. These findings may contradict traditional assumptions about surgical risk and obesity, highlighting the need to re‐evaluate the relationship between BMI and postoperative pulmonary complications.

BACKGROUND:Improved pain control after cesarean section remains a challenging objective. Although both the lateral quadratus lumborum block (L-QLB) and acupuncture have been reported to provide superior postoperative analgesia after cesarean section when compared to placebo, the efficacy of these techniques has never been compared head-to-head. OBJECTIVE:This study was conducted to investigate the comparative analgesic efficacy of L-QLB and acupuncture following elective cesarean section. STUDY DESIGN:In this prospective, randomized, controlled clinical trial, a total of 190 patients with singleton-term pregnancies scheduled for cesarean section under spinal-epidural anesthesia were enrolled. Patients were randomized 1:1 to acupuncture group or L-QLB group. L-QLB group received bilateral L-QLB with 0.33% ropivacaine and sham acupuncture, acupuncture group received transcutaneous electrical acupoint stimulation and press needle therapy, and sham L-QLB. All patients received the standard postoperative pain treatment. The primary outcome was pain scores on movement at 24 hours. Secondary endpoints included pain scores in the first 48 hours postoperatively, patient-controlled intravenous analgesia (PCIA) demands, analgesia-related adverse effects, postoperative complications, QoR-15, the time to mobilization, and gastrointestinal function. RESULTS:Median (interquartile range [range]) pain scores at 24 hours on movement were similar in patients receiving acupuncture or L-QLB (3 [2-4] vs 3 [2-4], respectively; P=.40). PCIA consumption and pain scores within 48 hours postoperatively also showed no difference between the two groups. The acupuncture improved QoR-15 scores at 24 and 48 hours postoperatively (P<.001), as well as shortened the time to first flatus (P=.03) and first drinking (P<.001) compared to L-QLB. In addition, the median time to mobilization in the L-QLB group was markedly prolonged compare with acupuncture group (17.0 [15.0-19.0] hours vs 15.3 [13.3-17.0] hours, estimated median difference, 1.5; 95% CI, 1-2; P<.001). CONCLUSION:As a component of multimodal analgesia regimen after cesarean section, acupuncture did not lower postoperative pain scores or reduce analgesic medication consumption compared to L-QLB.

Background: Placenta accreta spectrum (PAS) can easily lead to life-threatening hemorrhage. However, the association between placental thickness (PT) and massive bleeding remains unclear. Thus, this study investigated the association between PT and massive bleeding to determine which patients with suspected PAS and placenta previa were more likely to experience intraoperative hemorrhage. Methods: This retrospective cohort study was conducted between January 2018 and December 2020 at a general tertiary care hospital in Chongqing, China. Covariates included demographic, clinical, and ultrasonographic characteristics. Logistic regression analysis was used to explore the association between PT and massive bleeding. A sensitivity analysis was conducted by detecting trends in the association between PT quartile and massive bleeding risk. Results: PT was associated with a risk of massive intraoperative bleeding. The sensitivity analysis yielded a similar result using the minimally adjusted model (p for trend = 0.001), and minimal changes were observed using the crude and fully adjusted models (p for trend = 0.001 and 0.037, respectively). The risk of major bleeding was significantly higher in the fourth quartile (Q4) versus first quartile (Q1) group (odds ratio = 2.26, p = 0.034). A linear relationship was observed between PT and the risk of massive bleeding. Conclusions: PT was independently and linearly associated with the risk of massive bleeding. The risk of intraoperative hemorrhage was significantly higher in the higher PT (Q4) than lower PT (Q1) group. Clinical Trial Registration: The study was registered at Chinese Clinical Trial Registry (https://www.chictr.org.cn), registration number: ChiCTR2100044798.

This randomized controlled and double-blind study aimed to investigate whether the analgesic effect of the adductor canal block (ACB) combined with the genicular nerve block (GNB) after total knee arthroplasty is noninferior to that of the adductor canal block combined with local infiltration analgesia (LIA). A total of 102 patients undergoing total knee arthroplasty under general anesthesia were included and randomly divided into: ACB + GNB and ACB + LIA groups; the ACB + LIA group received 80 mL of 0.2

BACKGROUND:Patients who undergo laparoscopic bariatric surgery (LBS) are susceptible to postoperative nausea and vomiting (PONV). Opioid-free anesthesia (OFA) or opioid-sparing anesthesia (OSA) protocols have been proposed as solutions; however, differences between the 2 alternative opioid protocols for anesthesia maintenance in obese patients remain uncertain. A network meta-analysis was conducted to compare the impacts of OFA and OSA on PONV. METHODS:Systematic searches were conducted using Embase, PubMed, MEDLINE, and Cochrane Library databases to identify randomized controlled trials (RCTs) comparing OFA and OSA strategies. After screening according to the inclusion and exclusion criteria, we used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the credibility of the evidence. The main concern of this review was the difference between OFA and OSA in reducing PONV. The primary outcome was any PONV occurrence within 24 hours. Secondary outcomes included postoperative pain intensity, opioid consumption, opioid-related adverse events, and length of hospital stay. RESULTS:Fifteen RCTs involving 1310 patients were identified for a network meta-analysis from 1776 articles that compared OFA, OSA, and traditional opioid-based anesthesia (OBA) strategies in LBS. Twelve RCTs (80%) with 922 participants (70%) were eligible for the occurrence of PONV. These included 199 (22%) patients who received OFA and 476 (52%) and 247 (27%) patients who received OSA and OBA, respectively. OFA was more effective at reducing PONV (relative risks [RR], 0.6, 95% confidence interval [CI], 0.5-0.9, moderate-quality evidence) compared to OSA. No differences were observed in postoperative pain control or opioid consumption between the OFA and OSA strategies (very low-to high-quality evidence). Notably, OFA is associated with a higher risk of bradycardia than OSA (RR, 2.6, 95% CI, 1.2-5.9, moderate-quality evidence). CONCLUSIONS:OFA is more effective than OSA in reducing the occurrence of PONV during the early postoperative period of LBS, although it may associate with an increased risk of bradycardia. Patients who received either opioid-alternative strategy demonstrated similar effects in reducing postoperative opioid consumption and alleviating pain intensity.