This review focuses on energy conservation and emission reduction in the Central Sterile Supply Department (CSSD) of public hospitals. Based on policy frameworks including the Outline of the Healthy China 2030 Plan, the high-quality development initiative for public hospitals, and the "Three Transformations" strategy, and integrating the critical role of CSSD as the "master valve" for hospital infection control, this review systematically outlines the three-stage evolution of CSSD energy conservation and emission reduction: the passive energy-saving stage, the equipment and technology improvement stage, and the systematic management stage. Evidence was synthesized narratively from English- and Chinese-language literature published from inception to June 2025. By comprehensively analyzing existing literature, this review identifies the current bottlenecks faced by CSSDs, including challenges in technology adaptation, cross-departmental collaboration, intelligent system development, and cost-benefit balance. We propose three interrelated optimization pathways: precision technology, refined management, and integrated intelligence, and further discuss the challenges of transformation and future development directions toward a "safety-efficiency-low carbon" model. This review aims to provide theoretical support and practical guidance for energy conservation and emission reduction in CSSDs of public hospitals, assist hospitals in meeting the assessment target of "reducing energy consumption per 10,000 yuan of revenue", and promote the green and sustainable development of the medical industry.

Purpose:Chronic postsurgical pain (CPSP) is a common complication of video-assisted thoracoscopic surgery (VATS) and substantially impairs postoperative quality of life. We evaluated whether intercostal nerve block (ICNB) with liposomal bupivacaine provides superior chronic pain control compared with ropivacaine. Patients and Methods:We conducted a retrospective cohort study of 1325 adult patients who underwent elective VATS lung resection with ICNB administered using either liposomal bupivacaine or ropivacaine at the end of the surgery between September 2023 and August 2024. The primary outcome was the incidence of CPSP at 3 months postoperatively, defined as a numerical rating scale (NRS) pain score ≥1, a sensitive threshold to capture any postoperative pain. Secondary outcomes included NRS pain scores at rest at 24 and 48 hours postoperatively, cumulative opioid consumption within 48 hours, time to independent postoperative activities, length of hospital stay, and incidence of postoperative neuropathic pain at 3 months. Confounding was addressed using 1:1 propensity score matching with a 0.1 standard deviation caliper. Results:The median age was 61 years, and 59.9% were female. After propensity score matching, ICNB with liposomal bupivacaine was associated with a significantly lower incidence of CPSP at 3 months compared with ropivacaine (33.5% vs 42.3%; adjusted odds ratio, 0.68; 95% CI, 0.52 to 0.88; P=0.004). Patients receiving liposomal bupivacaine had reduced rest NRS pain scores at both 24 hours (3[2, 4] vs 4[3, 4]; P=0.002) and 48 hours (3[2, 3] vs 3[2, 4]; P=0.038). No significant differences were observed in other secondary outcomes. Conclusion:ICNB with liposomal bupivacaine was associated with reduced incidence of CPSP following VATS lung resection. These findings highlight the potential long-term analgesic benefit of liposomal bupivacaine and support the need for further randomised controlled trials evaluating long-term CPSP outcomes.

BackgroundPostoperative delirium (POD) is an acute disturbance of attention and awareness in older adults undergoing surgery. It is associated with prolonged hospital stay and increased morbidity and mortality. Recent studies suggested that neostigmine, an acetylcholinesterase inhibitor used to reverse neuromuscular blockade, may reduce POD risk. We aim to evaluate whether neuromuscular blockade reversal with neostigmine/glycopyrrolate reduces POD compared with sugammadex.MethodsThis single-center, triple-masked, randomized, controlled superiority trial will enroll 320 older adults scheduled for major non-cardiac and non-neurosurgical surgery. Patients will be randomized (1:1) to receive either neostigmine 40 μg/kg plus glycopyrrolate 8 μg/kg or sugammadex 2 mg/kg for neuromuscular blockade reversal at the end of surgery. The primary outcome is the incidence of POD within postoperative 7 days or until discharge, assessed twice daily with the validated Chinese version of 3-min Diagnostic Interview for Confusion Assessment Method. Secondary outcomes include days with POD and proportion of hospital days affected; POD severity assessed using the highest score and the sum scores of Confusion Assessment Method Severity; and 30-day cognitive function assessed using the 10-item Telephone Interview of Cognitive Status.DiscussionResults of this study will determine whether neostigmine/glycopyrrolate offers a simple, low-cost strategy to prevent POD and will inform evidence-based selection of neuromuscular reversal agents in older surgical patients.Trial registrationChinese Clinical Trial Registry (ChiCTR2400093158).

Substantial oxidative stress during myocardial ischemia/reperfusion (I/R) injury precipitates cell death and heart failure, for which translatable redox therapies remain scarce. Here, we show that nicotinamide riboside kinase 2 (NMRK2) is rapidly upregulated after reperfusion and exerts redox protection by a previously unrecognized mechanism. We established myocardial I/R injury in mice and hypoxia/reoxygenation (H/R) injury in cardiomyocytes. By elevating NADPH, restoring NAD+/NADH, increasing GSH/GSSG and activating Trx1, NMRK2 overexpression enhanced cellular antioxidant capacity and reduced oxidative damage during both myocardial I/R and cellular H/R injury. Knockdown of NAD kinase (NADK) abolished these protective effects. Mechanistically, nucleocytoplasmic fractionation and immunofluorescence confirmed robust Yes-associated protein (YAP) nuclear entry in NMRK2-overexpressing cells; Co-IP revealed NMRK2-induced disruption of the integrin β–YAP interaction; knockdown of integrin β reduced NADK expression and increased YAP phosphorylation at Ser127; and ChIP-qPCR and luciferase assays demonstrated that YAP directly binds the NADK promoter (−1500 to −1000 bp) for its transcriptional activation. In conclusion, NMRK2 sustains redox protection by disrupting the integrin β–YAP complex and driving YAP-dependent NADK transcription, providing a readily translatable therapy against myocardial I/R injury.

Myocardial injury after non-cardiac surgery (MINS) is a common and clinically important postoperative complication associated with increased short- and long-term mortality. As most cases lack typical ischemic symptoms, diagnosis relies primarily on systematic postoperative biomarker surveillance. Current guidelines recommend serial postoperative measurement of cardiac troponin (cTn) or high-sensitivity cTn, the reference-standard biomarker for myocardial necrosis, in patients at elevated perioperative risk. However, cTn demonstrates limited sensitivity during the early h following myocardial ischemia, underscoring the need for complementary biomarkers capable of detecting ischemic injury before the onset of irreversible myocardial necrosis or troponin elevation. This review summarizes recent advances in emerging circulating biomarkers for early MINS detection, including heart-type fatty acid-binding protein, ischemia-modified albumin, cardiac myosin-binding protein C, copeptin, and other markers reflecting ischemia, necrosis, inflammation, and fibrosis. We critically examine their underlying pathophysiological mechanisms, diagnostic performance, and release kinetics, highlighting their potential to shorten the diagnostic "blind window" associated with conventional biomarkers. The integration of multi-marker panels represents a promising strategy to enhance early diagnostic sensitivity and improve prognostic stratification. Nonetheless, large-scale prospective studies are required to validate their clinical utility and define their role in perioperative decision-making and guideline development.

Background:Whether opioid-free anesthesia (OFA) improves postoperative quality of recovery remains uncertain. This study aims to compare the effects of an intraoperative OFA protocol with traditional intraoperative opioid-based anesthesia (OBA) on recovery quality in patients undergoing gynecological laparoscopic surgery. Methods:This multicenter, randomized, double-blind, controlled trial will include 300 adult women scheduled for elective gynecological laparoscopic surgery at five tertiary hospitals in China. Patients will be randomized in a 1:1 ratio to either the OFA group (dexmedetomidine, esketamine, and lidocaine) or OBA group (sufentanil), stratified by study center. Following anesthesia induction, all patients will receive bilateral transversus abdominis plane blocks and propofol-based total intravenous anesthesia. The primary outcome is postoperative quality of recovery at 24 h, assessed using the Quality of Recovery-15 (QoR-15) questionnaire. Secondary outcomes include incidence of postoperative nausea and vomiting, QoR-15 scores at 48 and 72 h, numeric rating scale pain scores at rest and on coughing, cumulative opioid consumption, health-related quality of life and incidence of chronic pain at 3 months. Adverse events include hypotension, bradycardia, hypertension, tachycardia, oversedation, desaturation, dizziness, headache, ileus, hyperalgesia, psychiatric related side effects (hallucinations, agitation, nightmares, or delirium) occurring intraoperatively or during hospitalization. The primary analysis will be conducted according to the modified intention-to-treat principle. Discussion:We hypothesize that an intraoperative intravenous OFA regimen will enhance recovery quality compared with a traditional intraoperative OBA regimen in women undergoing gynecological laparoscopic surgery. The findings are expected to inform evidence-based optimization of anesthetic strategies in this surgical population. Trial registration number:https://www.chictr.org.cn, identifier (ChiCTR2500106392).

Introduction Adequate sedation is essential for paediatric patients undergoing invasive haematologic-oncologic procedures. The combination of propofol and remifentanil is commonly used yet is associated with respiratory depression. Esketamine has anaesthetic, analgesic and sympathomimetic properties and is known to cause less respiratory depression than other sedatives. This study aims to assess esketamine versus remifentanil in combination with propofol for invasive haematological-oncological procedures for paediatric patients.Methods and analysis This prospective, randomised, double-blind, two-period crossover trial will include 80 paediatric patients aged 6–12 years, with American Society of Anesthesiologists Physical Status II to III, who are scheduled to undergo repeated invasive procedures including bone marrow aspirates and lumbar punctures under sedation. Participants will be randomised to two sequences: AB or BA. In sequence AB, children will receive propofol (3 mg/kg) and esketamine (0.5 mg/kg) in period 1 and propofol (3 mg/kg) and remifentanil (1 µg/kg) in period 2. In sequence BA, the order is reversed. The primary endpoint of this trial is the incidence of desaturation events, defined as SpO2<90% during the sedation and recovery. The secondary endpoints include: (1) the interruption rate of the procedure; (2) total dose of propofol; (3) the number of times esketamine or remifentanil is added; (4) recovery time; (5) distress behaviour; (6) a composite of sedation-related adverse events, including psychotomimetic effects (hallucinations, nightmares, fatigue, dizziness and headache), nausea, vomiting, bradycardia and hypotension; (7) operator satisfaction; (8) patient satisfaction and (9) anaesthetist satisfaction.Ethics and dissemination The trial was approved by the Ethics Committee of the Children’s Hospital of Soochow University (Approval No. 2025008). The results of this trial will be submitted for peer review and publication in a scientific journal.Trial registration number ChiCTR2500098533.

Introduction Esophagectomy provokes an intense systemic inflammatory response that is significantly associated with postoperative morbidities. Whether a single preoperative high-dose dexamethasone can attenuate this response and improve recovery remains unknown.Patients and Methods This single-center, randomized, double-blind, parallel-group trial will enroll 82 adults undergoing elective transthoracic esophagectomy at the First Affiliated Hospital of Soochow University, Suzhou, China. Patients will be randomly assigned (1:1) to receive intravenous dexamethasone 15 mg (high-dose) or 5 mg (low-dose) during anesthesia induction. Both groups will receive standardized general anesthesia and perioperative care. The primary outcome is the peak plasma C-reactive protein (CRP) level within 72 h after surgery. Secondary outcomes include CRP values at 24, 48 and 72 h; 72-h recovery quality, assessed using the 15-item quality of recovery scale; cumulative 72-h opioid consumption; in-hospital major complications (anastomotic leakage, mechanical ventilation > 48 h, pulmonary infection, renal failure, reoperation, death); 7-d hyperglycemic events (> 10 mmol/L); and length of postoperative hospital stay.Discussion By comparing two clinically relevant dexamethasone doses, this trial will provide high-quality evidence on the efficacy and safety of using 15 mg dexamethasone to mitigate excessive systemic inflammation and improve recovery after esophagectomy.Trial registration Chinese Clinical Trial Registry (ChiCTR2500109536; registered on September 19, 2025)

Introduction Acute pain following pulmonary surgery can affect the recovery process of patients. The use of intrathecal morphine (ITM) injections offers a long-lasting analgesic effect, but its clinical application remains controversial. This study aims to investigate the impact of combining bupivacaine with ITM injections on the quality of postoperative recovery in patients who have undergone pulmonary surgery.Methods and design This multicentre, randomised, double-blind, controlled trial will enrol 254 patients undergoing elective lung surgery, who will be randomly assigned in a 1:1 ratio to either group IT (receiving an intrathecal injection of 3 mg bupivacaine and 0.25 mg morphine before general anaesthesia induction) or the control group (C group). The primary outcome includes postoperative recovery quality on day 1 (quality of recovery, QoR-15), with secondary outcomes encompassing postoperative recovery quality on days 2 and 3 (QoR-15), pain scores within 72 hours postoperatively, analgesic rescue, intraoperative haemodynamic parameters, opioid consumption, postoperative adverse reactions, recovery metrics, complications, chronic pain incidence and sleep quality.Ethics and dissemination The results will be disseminated through peer-reviewed publications. This study protocol (V.2.0, 30 October 2024) involves human participants and has been approved by the Ethics Committee of Affiliated Hospital of Yangzhou University (number 2024-08-02-2), Taicang Hospital Affiliated to Soochow University (number 2025 SR-041) and Yichang Central People’s Hospital (number 2024-513-02). Each individual who agrees to participate in the research will provide written informed consent after the objectives and procedures of this study are explained to them.Trial registration number ChiCTR2400092935. Registered on 26 November 2024.

BackgroundFlexible fiberoptic bronchoscopy is being increasingly carried out under general anesthesia in pediatric patients. However, the optimal anesthetic protocol still remains unclear. This study aims to test the hypothesis that the addition of low-dose rocuronium during laryngeal mask airway-assisted flexible fiberoptic bronchoscopy in children can enhance procedural outcomes and improve overall management.MethodsIn this randomized, double-blind, placebo-controlled trial, 140 children aged 1–6 years scheduled for flexible fiberoptic bronchoscopy under general anesthesia will be randomly allocated in a 1:1 ratio to either the rocuronium group or the normal saline group (n = 70 in each group). All children will receive intravenous propofol at a dose of 3 mg⋅kg–1 and remifentanil at 3 μg⋅kg–1 for anesthesia induction. This will be followed by either intravenous rocuronium at 0.3 mg⋅kg–1 or an equivalent volume of normal saline. Sevoflurane will be titrated to achieve the target anesthesia depth, while remifentanil will be initiated at a rate of 0.05 μg⋅kg–1⋅min–1 and subsequently adjusted as required. Mechanical ventilation will be performed via laryngeal mask airway and the bronchofiberscope is inserted through an adapter connected to the laryngeal mask airway. The primary endpoint, reflecting effectiveness of anesthesia, is the frequency of coughing episodes during the operation. Secondary endpoints include: (1) cumulative remifentanil dosage; (2) failure rate of flexible fiberoptic bronchoscopy operation; (3) hemodynamic changes; (4) cough scores in the post-anesthesia care unit; (5) procedure time; (6) discharge time; (7) adverse events; (8) satisfaction scores of bronchoscopist; (9) satisfaction scores of anesthesiologist; and (10) satisfaction scores of parents 24 h after the operation.DiscussionWe hypothesize that the addition of low-dose rocuronium during laryngeal mask airway-assisted flexible fiberoptic bronchoscopy under general anesthesia may optimize operation conditions, reduce coughing frequency, lower remifentanil dosage and the failure rate, stabilize hemodynamic fluctuations, minimize adverse events and enhance satisfaction, thereby providing valuable reference for clinical anesthesia practice in these procedures.Study Protocol Registrationhttps://www.chictr.org.cn/showprojEN.html?proj=277486, identifier [ChiCTR2500105407].

INTRODUCTION:Endoscopic retrograde cholangiopancreatography (ERCP) is associated with significant discomfort and necessitates adequate sedation. This study aims to determine the effect of dexmedetomidine nasal spray adjunct to propofol sedation for patients undergoing ERCP procedures. PATIENTS AND METHODS:This randomized, double-blind, placebo-controlled trial will be conducted at a tertiary teaching hospital in eastern China. Approximately 15 min before sedation, 160 adult patients will be randomly assigned (1:1) to either the dexmedetomidine group (dexmedetomidine nasal spray; n = 80) or the control group (normal saline nasal spray; n = 80). Sedation will be achieved with a target-controlled infusion of propofol, titrated to Modified Observer's Assessment of Alertness/Sedation scores of 1 and 2. The primary endpoint is the total propofol consumption during sedation. Secondary endpoints include the composite incidence of hypotension and hypoxemia during the procedures and recovery; and fatigue scores 15 min after emergence from sedation. An independent Data and Safety Monitoring Committee will conduct an ongoing review of study implementation. DISCUSSION:We anticipate that preoperative dexmedetomidine nasal spray will decrease total propofol requirements, reduce sedation-related adverse events, and enhance recovery for patients undergoing ERCP. TRIAL REGISTRATION:Chinese Clinical Trial Registry (ChiCTR2400093656) on December 10, 2024.

INTRODUCTION:Post-procedural fatigue is common after sedated gastrointestinal endoscopy and prolongs recovery. We describe a protocol for a prospective, single-center, randomized, controlled, 3 × 3 factorial trial to evaluate the effects of different sedative-analgesic combinations on patient-reported fatigue after gastrointestinal endoscopy. PATIENTS AND METHODS:Three hundred and fifteen patients (aged ≥ 45 years, ASA physical status I or II) presenting for gastrointestinal endoscopy with planned intravenous sedation will be randomly allocated (1:1:1:1:1:1:1:1:1; block sizes 9 and 18) to one of nine equip-sized groups generated by the factorial combination of three sedatives (propofol, ciprofol, remimazolam) with three adjuvant analgesics (sufentanil, esketamine, lidocaine). Sedation will be titrated to Modified Observer's Assessment of Alertness/Sedation scores of 1-2. The primary outcome is the Christensen Fatigue Scale score (range 1-10; higher = worse) 30 min after the procedure. The secondary outcome is the composite incidence of intra-procedural hypotension (mean arterial pressure < 65 mmHg) and hypoxemia (SpO2 < 90% for ≥ 10 s). Primary analysis will employ two-way factorial ANOVA to test the main effects of sedatives and analgesics on the 30-min fatigue score, with an exploratory interaction analysis. DISCUSSION:The results of this trial will provide high-resolution evidence on which sedative or analgesic agent most effectively mitigates early post-endoscopy fatigue, thereby informing patient-centered sedation choices and enhancing recovery. TRIAL REGISTRATION:Chinese Clinical Trial Registry (ChiCTR2500112657; registered on November 18, 2025).

BACKGROUND:Combined epidural-general anesthesia (TEA+GA) can enhance postoperative recovery after gastrointestinal surgery. However, in patients receiving preoperative neoadjuvant chemotherapy (NACT), a known risk factor for postoperative complications, it remains unclear whether TEA+GA improves postoperative outcomes. METHODS:This retrospective cohort study included 365 patients with NACT followed by radical resection of gastrointestinal cancer at Zhongshan Hospital between January 2020 and December 2022. TEA was initiated before the induction of GA. The primary outcome was the incidence of any postoperative in-hospital complications. Secondary outcomes included intraoperative sufentanil consumption, hypotension, vasopressor use, extubation time, post-anesthesia care unit stay, postoperative hospital length of stay, and intensive care unit admission. Inverse probability of treatment weighting (IPTW) and overlap weighting (OW) were applied to adjust for baseline differences. RESULTS:Of the 365 patients, 152 received TEA+GA, while 213 received GA alone. TEA+GA was associated with a significantly higher rate of postoperative complications (23.7% vs. 15.0%, OR [95% CI]: 1.76 (1.05-2.96), p = 0.036) without subgroup difference. This association remained significant after IPTW (24.1% vs 11.7%, OR [95% CI]: 2.39 [1.24-4.59], p = 0.009) and OW (23.3% vs 10.4%; OR [95% CI]: 2.62 [1.36-5.08], p = 0.004) adjustment. The TEA+GA group had a lower dose of intraoperative sufentanil use and shorter extubation times but showed a higher rate of intraoperative hypotension and increased vasopressor requirements. CONCLUSIONS:In patients who underwent NACT followed by gastrointestinal radical surgery, Combined epidural-general anesthesia was associated with an increased incidence of postoperative in-hospital complications.

BACKGROUND:Postoperative sleep disturbance (PSD) after major abdominal surgery in older adults is common and impairs recovery. Dexmedetomidine is a selective α2-adrenergic agonist with sedative, analgesic, and anti-inflammatory properties that promotes natural sleep. We hypothesized that intraoperative dexmedetomidine would reduce PSD in this population. METHODS:In this randomized, double-blind, placebo-controlled trial, 210 older adults undergoing major abdominal surgery were randomly assigned (1:1:1) to receive intraoperative normal saline, dexmedetomidine 0.3 μg/kg/h, or 0.6 μg/kg/h. The primary outcome was PSD on the first postoperative night (Athens Insomnia Scale score ≥ 6). Secondary outcomes included PSD on until nights 30; pain at 24 and 48 h; delirium and depressive symptoms within 7 days; and recovery quality on postoperative days 1‒3. Sleep patterns on nights 1 and 2 were assessed using wrist actigraphy. This trial was registered on the Chinese Clinical Trial Registry (Identifier: ChiCTR2300073163; principal investigator: Ke Peng; dated July 23, 2023; https://www.chictr.org.cn/showproj.html?proj=199410). RESULTS:203 patients (median age 71 years; 67.5% male) completed this trial. Compared with normal saline (n = 67), both low-dose (n = 68) and high-dose dexmedetomidine (n = 68) significantly reduced first-night PSD (20.6% vs 65.7%; relative risk 0.31, 95% CI 0.19-0.50; NNT 2.2; P < 0.001; and 11.8% vs 65.7%; relative risk 0.18, 95% CI 0.09-0.34; NNT 1.8; P < 0.001, respectively). The two doses did not differ. Dexmedetomidine was associated with lower sleep disturbance on night 2 and higher recovery quality, without between-group differences in hypotension, bradycardia, delirium, or 30-day mortality. Exploratory actigraphy analysis (n = 20 per group) showed longer total sleep time and lower wake-time percentage associated with dexmedetomidine. CONCLUSIONS:Intraoperative dexmedetomidine infusion reduced the relative risk of first-night PSD by 70-80% among older adults undergoing major abdominal surgery. These findings require confirmation in multicenter trials.

Background: Acute traumatic musculoskeletal injuries often result in persistent pain and disability despite physical recovery. Virtual reality (VR) provides an innovative approach for overcoming treatment barriers and may help address psychological risk factors for persistent pain and disability. However, the neural mechanisms underlying VR, particularly in subacute orthopedic pain, are insufficiently understood. Objective: This pilot study examined the feasibility, acceptability, and neural correlates of an 8-week home-based therapeutic VR intervention (RelieVRx) for subacute (<2 mo postinjury) musculoskeletal pain, using functional near-infrared spectroscopy (fNIRS) to assess changes in prefrontal cortex (PFC) activation and coactivation. Methods: Ten orthopedic patients (mean age 46.8, SD 11.86 years; 7/10, 70% female) completed the RelieVRx intervention and underwent fNIRS and behavioral assessments before and post treatment. Behavioral measures included pain intensity, pain interference, pain catastrophizing, pain anxiety, mindfulness, coping, and pain self-efficacy. fNIRS recorded PFC hemodynamic responses during movement-evoked pain and VR-based relaxation/distraction tasks. Feasibility and acceptability were assessed qualitatively and quantitatively (valid fNIRS recordings, participant feedback). Analyses evaluated pre-post changes in PFC activation, functional coactivation, and correlations with behavioral measures. Results: fNIRS procedures demonstrated high feasibility (74/80, 93% valid recordings), acceptability, and there were no safety concerns. Significant improvements were observed across all behavioral measures, including reduced pain intensity at rest (mean difference [MD]=-2.50, P<.001, d=2.24), and with activity (MD=-3.40, P<.001, d=1.98), decreased pain interference (MD range -3.90 to -4.90, P<.001, d range 1.32 to 2.30), reduced pain anxiety (MD=-32.70, P=.001, d=2.14) and pain catastrophizing (MD=-16.40, P=.003, d=2.13), and improved mindfulness (MD=+3.29, P=.01, d=0.94), coping (MD=+0.59, P=.01, d=1.01), and self-efficacy (MD=15.40, P=.008, d=1.51). fNIRS showed significant posttreatment increases in medial PFC activation (right medial channel: distraction task t=-4.473, P=.004; relaxation task t=-3.036, P=0.02) and enhanced coactivation between medial and lateral PFC regions (distraction task t=-2.784, P=.03). Increased functional coactivation between the right medial and left lateral PFC was negatively correlated with improved mindfulness (r=-0.716, P=.046) and coping scores (r=-0.709, P=.049). Conclusions: This study provides initial evidence of the feasibility and acceptability of integrating fNIRS neuroimaging into clinical VR interventions. Results indicate that engagement with VR therapy was associated with alterations in neural activity in key PFC regions implicated in pain regulation, correlating with significant improvements in pain and behavioral measures. The neural and behavioral changes highlight the potential of VR as a mechanistically informed, scalable nonpharmacological approach to managing subacute pain following orthopedic injuries. These findings justify larger trials that incorporate multimodal neuroimaging to further understand potential mechanistic processes that may underlie VR-based pain therapies.

INTRODUCTION:Endoscopic retrograde cholangiopancreatography (ERCP) in older adults is frequently complicated by intra-procedural desaturation and inflammation, delaying recovery. We compare high-flow nasal cannula (HFNC) oxygenation with standard therapy for improving post-procedural recovery quality and attenuating inflammation. PATIENTS AND METHODS:This single-center, prospective, randomized, patient- and assessor-blinded, parallel-group trial will enroll 106 in-patients aged ≥ 70 years scheduled for elective ERCP under sedation. Following esketamine 0.25 mg/kg and propofol target-controlled infusion (plasma concentration 2.5 µg/mL), patients will be randomly allocated (1:1) to receive either HFNC oxygenation (40 L/min, 100% O2, 37 °C) or standard nasal cannula oxygenation (5 L/min). The primary endpoint is quality of recovery at 24 h post-procedure, assessed using the 15-item Quality of Recovery (QoR-15) scale. Secondary endpoints include the incidence of desaturation (SpO2 < 90% for ≥ 10 s), time to emergence, serum inflammatory biomarkers, and post-procedural morbidity. Analyses will follow the intention-to-treat principle, with adjustment for prespecified covariates using a generalized linear model. DISCUSSION:We hypothesize that HFNC oxygenation will improve 24-h QoR-15 scores, reduce intra-procedural desaturation, and attenuate systemic inflammatory response compared with standard nasal cannula oxygenation. The findings will inform evidence-based respiratory support strategies during ERCP in older adults. TRIAL REGISTRATION:Chinese Clinical Trial Registry (Identifier: ChiCTR2500105743).

Background Sleep disorders profoundly impair patients’ daily quality of life and present substantial challenges to clinical management. Accumulating evidence has shown that propofol improves sleep architecture and quality in clinical practice, yet its mechanism in modulating pain linked to sleep disorders remains elusive. Given that chronic sleep disruption is often accompanied by impaired pain thresholds and imbalances between excitatory and inhibitory neurotransmitters, this study aimed to determine whether propofol alleviates sleep-deprivation-induced pain threshold reduction by modulating this neurotransmitter balance. Methods A modified multi-platform water maze was used to establish a sleep-deprived mouse model simulating sleep disruption. Following tail vein administration of varying propofol doses, behavioral assessments were conducted to evaluate its effects on sleep states and pain thresholds. Concurrently, electroencephalogram (EEG) and electromyogram (EMG) recordings captured sleep rhythm alterations. To further investigate neurochemical mechanisms, 9.4 T MRI and amino acid metabolism analysis were employed to obtain magnetic resonance spectroscopy (MRS) data. Glutamate (Glu) and γ-aminobutyric acid (GABA) levels in the thalamus and cortex were measured to assess dynamic changes in the excitatory/inhibitory neurotransmitter balance. Results Our results demonstrated that sleep deprivation significantly reduced the pain threshold in mice, which was accompanied by an imbalance in the thalamocortical Glu/GABA ratio. Propofol intervention markedly restored this neurotransmitter imbalance — the Glu/GABA metabolic ratio returned to a relatively stable level, and the reduced pain threshold was significantly improved. Concurrent EEG and EMG recordings revealed that propofol optimized sleep architecture and partially reversed sleep rhythm disturbances caused by sleep deprivation. Conclusions In summary, propofol effectively alleviates sleep-deprivation-induced pain reduction in pain threshold. This analgesic effect is associated with the restoration of the dynamic equilibrium of excitatory/inhibitory neurotransmitters (Glu/GABA) in the thalamocortical circuit. Our findings provide novel experimental and neurochemical evidence supporting the potential application of propofol in sleep disorders and associated pain management, thereby offering a valuable reference for future clinical translational research.

Background:Acute kidney injury (AKI) is a common complication in elderly patients undergoing orthopedic surgery, yet the renoprotective role of dexmedetomidine in this patient population remains unclear. This study aimed to evaluate the effect of dexmedetomidine on the incidence of AKI in elderly patients undergoing lower extremity orthopedic procedures. Methods:In this randomized, double-blind, placebo-controlled trial, 300 patients aged ≥ 65 scheduled for lower extremity orthopedic surgery were randomized to receive either dexmedetomidine (0.4 μg/kg infused for 10 minutes before induction, followed by 0.4 μg/kg/h until 30 minutes before skin closure) or normal saline (control). The primary outcome was the incidence of AKI within 48 hours postoperatively, based on AKI Network criteria. Secondary outcomes included serum cystatin C and estimated glomerular filtration rate on postoperative day (POD) 1, 2, and 3, in-hospital complications (postoperative nausea and vomiting, delirium, pneumonia, stroke), intensive care unit admission, length of hospital stay, and in-hospital mortality. Results:Of 295 patients who completed the study (62.7% female; mean age, 74 years), AKI occurred in 4.7% (7/149) of the dexmedetomidine group compared with 11.6% (17/146) of the control group (odds ratio = 0.37; 95% CI, 0.15 to 0.93; P = 0.035). This difference remained significantly after adjustment for baseline covariates (adjusted odds ratio = 0.36; 95% CI, 0.14 to 0.90; P = 0.030). All AKI cases were AKIN stage 1. Serum cystatin C on POD 1 were lower in the dexmedetomidine group (mean [SD], 1.06 [0.30] vs 1.17 [0.32] mg/L; P = 0.003). No significant between-group differences were observed in other secondary outcomes. Conclusion:Dexmedetomidine administration was associated with a reduced incidence of AKI in elderly patients undergoing lower extremity orthopedic surgery. The renoprotective effects of dexmedetomidine in this patient population warrant validation in multicenter trials. Clinical Trial Registration:Chinese Clinical Trial Registry (ChiCTR2400088225).