Background: Empirical antibiotic selection for gram-negative bloodstream infection is made before definitive susceptibility results are available. Patient-specific susceptibility ranking may support this decision, but recommendation-level performance, clinician prescribing comparators, and external transportability remain insufficiently evaluated. Methods: We conducted a retrospective clinical decision-support modelling study in MIMIC-IV anchored to index blood-culture collection. Adult hospital-acquired gram-negative bloodstream infection episodes were split at subject level into training, validation, and test sets. Predictors were restricted to pre-index or encounter information, and susceptibility phenotypes were outcome labels. Drug-specific logistic regression and gradient-boosted tree models were developed for piperacillin-tazobactam, cefepime, and meropenem, with ciprofloxacin and gentamicin as secondary targets. Ranking rules were selected in validation and tested in complete-panel episodes. Observed empirical therapy from medication administrations 6 hours before to 24 hours after culture collection was used as a prescribing-context benchmark. Per-drug decision curve analysis and ARMD-MGB external drug-specific transportability were assessed. Results: In MIMIC-IV, 1004 episodes from 962 patients were analysed. In 192 complete-panel test episodes, the selected all-gradient-boosted-tree rule achieved Top-1 coverage of 91.1% (175/192) and Top-2 coverage of 96.4% (185/192). Meropenem-for-all covered 93.2% (179/192), and meropenem accounted for 90.1% of model Top-1 recommendations. Compared with observed clinician therapy, the model showed higher apparent active coverage (91.1% vs 39.6%; paired risk difference 51.6 percentage points, 95% CI 43.9-59.2; exact McNemar p < 0.001) but greater meropenem use (90.1% vs 9.9%). Decision curve analysis showed drug- and threshold-dependent net benefit, with limited interpretability for meropenem because susceptible prevalence was high. In ARMD-MGB, external AUROCs for gradient-boosted trees were 0.671, 0.754, and 0.677 for piperacillin-tazobactam, cefepime, and meropenem; calibration remained imperfect. Conclusions: Patient-specific susceptibility ranking produced high retrospective active coverage, but mainly through meropenem-heavy recommendations. External testing supported drug-specific transportability rather than direct transfer of the prescribing policy. Empirical antibiotic decision support should report active coverage and carbapenem exposure together before clinical use. Trial registration: Not applicable.

During laparoscopic cholecystectomy, pneumoperitoneum reduces pulmonary compliance, which may result in atelectasis and postoperative hypoxia. The efficacy of laryngeal mask ventilation during laparoscopic surgery is currently up for dispute. The objective of this study is to determine whether a Laryngeal Mask Airway Supreme™ (LMA-S) is non-inferior to an endotracheal tube (ETT) in maintaining lung compliance among low-risk patients undergoing laparoscopic cholecystectomy. The findings could be applied to implement novel airway management strategies for laparoscopic cholecystectomy procedures. A total of 100 American Society of Anaesthesiologists Classification (ASA) I–II patients will be randomly allocated to airway management with an LMA-S (L group, n = 50) or an ETT (T group, n = 50). After the induction of general anaesthesia, patients in group L will receive LMA-S, while patients in group T will receive ETT. Lung-protective ventilation strategy (LPVS) will be employed throughout the procedure in both groups. The primary outcome is pulmonary dynamic compliance (Cdyn) 15 min after pneumoperitoneum and up-head position. Secondary outcomes include the oxygenation index (OI), peak inspiratory pressure (PIP), end-expiratory carbon dioxide (EtCO2), Richmond Agitation-Sedation Scale (RASS) scores, perioperative hemodynamics, and adverse respiratory events. This study will evaluate the effects of LMA-S ventilation on Cdyn and oxygenation in patients undergoing laparoscopic cholecystectomy. Clinical evidence to optimize airway management strategies for low-risk patients undergoing laparoscopic cholecystectomy will be provided by the results. China Clinical Trial Registry (ChiCTR2400083333). Registered 22 April 2024, https://www.chictr.org.cn.

Inferior vena cava (IVC) respiratory variability is widely used to assess volume status and fluid responsiveness, but its interpretation depends on the physiological context. During rigid bronchoscopy, jet ventilation creates a distinct ventilatory environment, and its impact on IVC-derived indices remains unclear. This prospective self-controlled observational study included 60 adult patients undergoing rigid bronchoscopy under general anesthesia. Measurements were obtained at three predefined time points: awake baseline (T0), mask-assisted positive-pressure ventilation during induction (T1), and stable intraoperative jet ventilation (T2). IVC parameters were assessed using M-mode ultrasonography. The primary outcome was the paired change in IVC distensibility index (dIVC) between T1 and T2. dIVC decreased significantly from T1 to T2 (86.29 ± 35.09

Background: Dezocine has been used for postoperative analgesia. However, its combination with sufentanil on postoperative recovery quality remains poorly understood. Methods: The Ease Go multicenter randomized controlled trial recruited 210 patients undergoing laparoscopic thoracic surgery from eight tertiary academic medical centers. The dezocine–sufentanil group received dezocine 1.0 mg/kg combined with sufentanil 2.0 μg/kg, while the sufentanil monotherapy group received sufentanil 3.0 μg/kg via a patient-controlled intravenous analgesia (PCIA) pump. The primary outcome was the quality of recovery (QoR-15) at 24 hours after PCIA pump initiation. The secondary outcomes included qualified recovery quality, patient global impression of change, the effective number of analgesic pump compressions, postoperative pain scores, as well as the use of rescue analgesics within 48 hours after PCIA pump initiation. Results: The mean QoR-15 scores at 24 and 48 hours after PCIA pump initiation in the dezocine–sufentanil vs. sufentanil group were 111.16 vs. 108.12 ( P = 0.321) and 121.96 vs. 120.14 ( P = 0.501), respectively. A higher proportion of qualified recovery quality was observed in the dezocine–sufentanil group (71.72% vs. 57.00%, P = 0.030 at 24 hours; 78.79% vs. 63.00%, P = 0.014 at 48 hours). The pain score was significantly lower in the dezocine–sufentanil group compared to the sufentanil group at 2, 4, 6, and 12 hours after PCIA pump initiation (all P < 0.05). The effective number of analgesic pump compressions (6.54 vs. 11.85, P = 0.001) and the proportion of patients requiring rescue medication (18.18% vs. 32.00%, P = 0.025) within 48 hours after pump initiation were both lower in the dezocine–sufentanil group. Conclusions: The QoR-15 score after laparoscopic thoracic surgery was not improved by the combined analgesia with dezocine and sufentanil. Nevertheless, the combined analgesia provided a higher qualified recovery quality rate and fewer analgesic requirements than sufentanil analgesia.

Purpose:The oculocardiac reflex (OCR) is a frequent and potentially hazardous complication during pediatric strabismus surgery. Achieving hemodynamic stability while ensuring rapid recovery is critical in day-case anesthesia. This study aimed to evaluate the efficacy of a sub-anesthetic dose of esketamine in reducing the incidence of OCR in children undergoing day-case strabismus surgery under total intravenous anesthesia (TIVA). Patients and Methods:This prospective, randomized, double-blind, placebo-controlled trial enrolled 204 children (aged 2-12 years, ASA I-II) scheduled for elective strabismus surgery. Patients were randomized (1:1) to receive either intravenous esketamine (0.2 mg/kg) or an equal volume of normal saline following laryngeal mask airway insertion. All patients received standardized TIVA with propofol and remifentanil. The primary outcome was the overall incidence of OCR (defined as a heart rate decrease >20% from baseline or arrhythmia upon muscle traction). Secondary outcomes included OCR incidence during three distinct surgical stages: Stage I (conjunctival incision), Stage II (active muscle mobilization and dissection), and Stage III (static sustained muscle traction), as well as severe OCR (<50 bpm), and postoperative recovery quality. Results:The overall incidence of OCR was significantly lower in the esketamine group compared to the control group (38.2% vs 70.6%; P < 0.05). Heart rates dynamics varied by stage, with the highest OCR incidence occurring during Stage II (37.3% vs 70.6%; P <0.05) compared to Stage III (1.0% vs 6.9%; P =0.071) in both groups. Heart rates in the esketamine group were significantly higher during conjunctival incision (Stage I) and muscle dissection (Stage II) (P < 0.001). For both groups, Stage II was associated with the highest incidence of OCR. Although the incidence of severe OCR was lower in the esketamine group (2.9% vs 8.8%), the difference was not statistically significant. There were no significant differences between groups regarding postoperative nausea and vomiting, emergence agitation, or time to discharge. Conclusion:A single sub-anesthetic dose of esketamine (0.2 mg/kg) effectively reduces the incidence of OCR and enhances hemodynamic stability in children undergoing day-case strabismus surgery. This regimen provides a safe prophylactic strategy without compromising recovery quality or increasing postoperative adverse events.

BACKGROUND:High-flow nasal oxygen may offer benefits for maternal during cesarean delivery. However, its effects on fetal acid-base status remain understudied. The objective of this study was to determine if high-flow nasal oxygen improves fetal acid-base outcomes compared to room air in patients undergoing elective cesarean delivery under combined spinal-epidural anesthesia. METHODS:Patients undergoing elective cesarean delivery, gestation age of at least 37 weeks, age between 18 and 45 were eligible. Participants were randomly assigned 1:1 to receive either high-flow nasal oxygen at 40 L/min with 100% oxygen or room air at 2 L/min after epidural catheter placement until delivery. The primary outcome was umbilical artery lactate level. Secondary outcomes included umbilical artery pH, partial pressure of oxygen, partial pressure of carbon dioxide, Apgar scores, and oxidative stress markers. RESULTS:Between July to December 2023, 112 completed the study protocol. The high-flow nasal oxygen group had significantly lower umbilical artery lactate levels (1.60 [1.30-1.80] mmol/L vs. 1.80 [1.50-2.30] mmol/L; P = 0.003) and higher umbilical artery pH (7.32 [7.30-7.35] vs. 7.31 [7.28-7.33]; P = 0.004). The high-flow nasal oxygen group also showed improved umbilical artery partial pressure of oxygen (17.34 ± 3.73 vs. 15.67 ± 3.36 mmHg; P = 0.022) and lower partial pressure of carbon dioxide (50.10 [46.50-53.10] vs. 52.60 [48.35-56.65] mmHg; P = 0.003). No significant differences were observed in Apgar scores, oxidative stress markers, or other short-term neonatal outcomes between groups. CONCLUSIONS:High-flow nasal oxygen during elective cesarean delivery under combined spinal epidural anesthesia appears to improve fetal acid-base status and oxygenation without increasing oxidative stress. These findings emphasize that high-flow nasal oxygen does not adversely affect feta acid-base status, supporting its safety profile in low-risk pregnancies. This safety signal provides a rationale for further studies in higher-risk maternal populations. TRIAL REGISTRATION:This study is registered at ClinicalTrials.gov with the registration ID: NCT05921955.

Intraoperative hypothermia is common during video-assisted thoracoscopic surgery (VATS) because of prolonged exposure of the pleural cavity and the thermoregulatory effects of anesthesia. Despite its clinical relevance, predictive tools tailored to VATS remain limited. This study aimed to develop and validate a practical model to identify patients at increased risk of intraoperative hypothermia. This retrospective study included 651 patients who underwent VATS at a tertiary hospital in Beijing (January 2023–August 2025). Thirty-three perioperative variables were assessed. Predictors were selected using least absolute shrinkage and selection operator (LASSO) regression, and multivariable logistic regression was performed to build the model. Restricted cubic spline (RCS) analysis was applied to explore potential nonlinear associations between continuous predictors and intraoperative hypothermia. A nomogram was developed and internally validated by 1000 bootstrap resamples. Model performance was evaluated in terms of discrimination, calibration, and clinical utility using receiver operating characteristic (ROC) analysis, calibration plots, the Hosmer–Lemeshow test, and decision curve analysis (DCA). Intraoperative hypothermia occurred in 407 patients (62.52

Purpose:Postoperative recovery quality is a key concern for elderly patients undergoing spinal surgery, yet evidence comparing different anesthetic techniques in this population remain limited. This study aimed to compare the quality of recovery between desflurane-based inhalational anesthesia and propofol-based total intravenous anesthesia in this population. Patients and Methods:This randomized non-inferiority trial was conducted from July 1 to October 31, 2025. A total of 109 elderly patients scheduled for spinal surgery were randomly assigned to two groups: the desflurane group (group D), which received desflurane at a maintenance dose of 0.7 to 1.0 MAC, and the propofol group (group P), which received propofol at 4 to 6 mg/kg/h. Both groups received standard monitoring and invasive arterial blood pressure measurement. The primary outcome was the quality of recovery (QoR-15) scores on postoperative day 1 (POD1). Secondary outcomes include intraoperative remifentanil and vasopressors requirements, fluid volume, hemodynamic parameters, emergence profiles, duration of post-anesthesia care unit (PACU) stay, postoperative hospital length of stay, Activities of Daily Living (ADL) scale, Mini Montreal Cognitive Assessment (Mini-MoCA), Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), incidence of postoperative nausea and vomiting (PONV), Numeric Rating Scale (NRS) of postoperative pain and subjective sleep quality on POD1 and POD2. Results:The total QoR-15 score on POD1 in group D was non-inferior to that in group P (117.0 ± 10.6 vs. 118.4 ± 12.0; mean difference: -1.4; 95% CI: -5.6-2.4; one-sided P=0.017 for non-inferiority). Compared with group P, group D had significantly shorter times to extubation, eye opening, limb movement, orientation recovery, and ability to state one's name, as well as significantly higher Riker Sedation-Agitation Scale scores. Intraoperative phenylephrine consumption and fluid volume were lower in group D than in group P. No significant differences were observed between the two groups in PACU stay duration, postoperative hospital length of stay, ADL scale, Mini-MoCA, CAM-ICU, PONV incidence, NRS pain scores, or subjective sleep quality. Conclusion:Desflurane-based inhalational anesthesia provided a non-inferior quality of recovery compared with propofol. Additionally, desflurane was associated with faster emergence and lower vasopressor requirements. Desflurane and propofol can be considered interchangeable for general anesthesia in elderly patients undergoing spinal surgery.

BACKGROUND:Good quality of postoperative recovery is crucial for daytime surgery due to the short hospitalization and limited observation time. Remimazolam has unique advantages in hemodynamics for elders. This clinical trial compared remimazolam with propofol for the quality of postoperative recovery among elders who received ocular fundus daytime surgery. METHODS:The current prospective, multicenter, randomized clinical trial recruited 291 elderly patients who underwent ocular fundus daytime surgery from five medical centers. All cases were classified into a remimazolam group (N.=145) given 0.3 mg/kg remimazolam to induce anesthesia and later1-2 mg/kg/h to maintain the anesthesia, or a propofol group (N.=146) given 1.5-3 mg/kg propofol to induce anesthesia and subsequently 4-10 mg/kg/h for the maintenance of anesthesia. The quality of recovery scale-15 (QoR-15) score 24 h postoperatively was the primary outcome. RESULTS:The remimazolam group had comparable QoR-15 scores 24 h postoperatively compared to the propofol group (137.66 [8.53] vs. 138.24 [8.15]; mean difference [95% CI: -0.58 -2.50, 1.35]). The hemodynamics of the remimazolam group was more stable than in the propofol group. Relative to the propofol group, the time to consciousness loss during induction was prolonged, and the times for recovery after operation and laryngeal mask removal of the remimazolam group were shortened. CONCLUSIONS:Remimazolam was non-inferior to propofol regarding postoperative recovery among elderly patients receiving ocular fundus daytime surgery. Compared to propofol, remimazolam facilitated more stable hemodynamics and shorter recovery times.

To evaluate the efficacy and safety of NH600001, a novel etomidate derivative, in gastrointestinal endoscopy, as well as its impact on adrenocortical function, two multicenter, double-blind, randomized, controlled clinical trials(NH600001-21 [Phase II trial] and NH600001-31 [Phase III trial]) were conducted in China. In NH600001-21, 160 gastroscopy subjects were randomized 1:1:1:1 to receive NH600001 (0.20, 0.25, or 0.30 mg/kg) and etomidate (0.30 mg/kg). In NH600001-31, 344 gastroscopy or colonoscopy subjects were randomized in a 1:1 ratio to receive NH600001 (0.25 mg/kg) and etomidate (0.30 mg/kg). The primary efficacy outcome was the rate of endoscopic success. Additionally, Safety and effects on adrenocortical function were also assessed. In NH600001-21, the 0.25 mg/kg NH600001 showed non-inferiority to etomidate based on the prespecified non-inferiority margin of -8% (Rate Difference [95% confidence interval], 5.0[-4.49 to 14.49]), whereas the 0.20 mg/kg and 0.30 mg/kg NH600001 did not meet statistical non-inferiority criteria (0[-11.54 to 11.54]; 0[-11.54 to 11.54]). The area under curve (AUC) of plasma cortisol change values within 0-4 h (∆Cortisol AUC0-4h) were significantly higher in the NH600001 treatment groups than in the etomidate group (P < 0.01). In NH600001-31, NH600001 (0.25 mg/kg) showed non-inferiority to etomidate (1.16[-0.44 to 2.76]). ∆Cortisol AUC0-4h in the NH600001 group, versus the etomidate group, were significantly higher (P < 0.001). Furthermore, NH600001 had a safety profile comparable to etomidate and elicited fewer myoclonus adverse events. In Conclusions, NH600001 has a sedative/anesthetic effect comparable to etomidate while reducing the risk of adrenocortical depression with a favorable safety profile. Chictr.org.cn identifier: ChiCTR2300069841, ChiCTR2400084095. Clinical Trial Number and Registry URL: NH60001-21, Identifier, ChiCTR2300069841 (Changsha, China;, principal investigator: Wen Ouyang, first registration date: March 28, 2023), https://www.chictr.org.cn ; NH60001-31, Identifier, ChiCTR2400084095 (Changsha, China, principal investigator: Wen Ouyang, first registration date: May 10, 2024), https://www.chictr.org.cn .

Purpose: Pulmonary atelectasis frequently develops during laparoscopic procedures under general anesthesia, often leading to postoperative pulmonary complications (PPCs). Given the connection between high driving pressure and these complications, this study employed ultrasonography to assess whether individualized positive end-expiratory pressure (PEEP) titration by minimum driving pressure reduces postoperative atelectasis. Patients and Methods: Adult patients with medium-to-high-risk PPCs who were scheduled for laparoscopic procedures were allocated to receive either a fixed PEEP of 5 cmH2O (Group C) or minimum driving pressure-guided individualized PEEP (Group D). The primary outcome was the lung ultrasound score (LUS) on postoperative day 1, and LUSs at other postoperative time points were also recorded. The secondary outcomes were occurrence of atelectasis evaluated by ultrasonography and occurrence of PPCs within 7 days postoperatively. Results: A total of 106 participants were assigned randomly, with 102 included in the final analysis. Individualized PEEP resulted in better intraoperative respiratory mechanics. Compared with Group C, Group D demonstrated a more substantial decrease in the LUS on postoperative day 1 (4[3-6] vs 6[5-8], P < 0.001), and this benefit persisted until postoperative day 3. Moreover, the occurrence of atelectasis evaluated by ultrasonography in Group D was considerably lower than that in Group C at 15 min after extubation (58.8% vs 80.4%, P = 0.018), and this advantage persisted until postoperative day 2. Compared with Group C, Group D experienced fewer PPCs within 7 days after surgery (13.7% vs 31.4%, P = 0.033), whereas other postoperative recovery indicators were not significantly different. Conclusion: In adult patients undergoing laparoscopic surgery, compared with a fixed PEEP of 5 cmH2O, the driving pressure-guided individualized PEEP strategy improved postoperative LUSs and reduced incidences of early postoperative atelectasis assessed by ultrasound. Furthermore, it was associated with fewer PPCs and lower rates of atelectasis in the first 7 postoperative days.

Postoperative pain and sleep disturbance are common after endoscopic sinus surgery (ESS) and may delay postoperative recovery. Acupuncture has demonstrated analgesic and sleep-enhancing effects in perioperative care; however, the impact of cheek acupuncture—a minimally invasive facial microsystem technique—on postoperative recovery after ESS has not been evaluated in randomized controlled trials. This single-center, prospective, randomized controlled pilot trial will enroll 90 adults undergoing ESS. Participants will be randomized 1:1 to receive cheek acupuncture or sham cheek acupuncture within 30 min before anesthesia induction. The primary outcome is the Quality of Recovery-15 (QoR-15) score at 24 h postoperatively. Secondary outcomes include the Insomnia Severity Index (ISI), Numerical Rating Scale (NRS) for pain, intraoperative hemodynamics, postoperative care unit (PACU) stay duration, postoperative nausea and vomiting (PONV), and inflammatory biomarkers (serum interleukin-6 [IL-6] and C-reactive protein [CRP]). This trial will assess the feasibility, safety, and preliminary efficacy of cheek acupuncture in improving postoperative recovery after ESS. Results will inform the design of a future multicenter randomized trial. Chinese Clinical Trial Registry (ChiCTR2500110625). Registered on 16 October 2025.

Purpose:To evaluate the efficacy of an intelligent closed-loop warming system compared with conventional warming methods in preventing perioperative hypothermia and improving postoperative recovery in patients undergoing video-assisted thoracoscopic surgery (VATS). Patients and Methods:A total of 118 adult patients scheduled for elective VATS were randomly assigned to the conventional warming group (n = 59) or the intelligent closed-loop warming group (n = 59). Conventional warming management employed an underbody warming blanket, supplemented with blood and fluid warming when core temperature fell below 36.0°C. The intelligent closed-loop warming system utilized wireless sensors and an automated feedback-controlled warming unit to maintain core temperature between 36.5°C and 37.0°C. Core temperature was continuously monitored from anesthesia induction to post-anesthesia care unit (PACU) discharge. The primary outcome was the incidence of perioperative hypothermia (core temperature < 36.0°C). Secondary outcomes included mean and minimum intraoperative temperature, extubation time, PACU temperature, postoperative complications, length of hospital stay (HLOS), and hospitalization cost. Results:Perioperative hypothermia occurred in significantly fewer patients in the intelligent group than in the conventional group (25.4% vs. 76.3%, p < 0.001). The intelligent closed-loop warming system maintained higher mean (36.40 ±0.33°C vs. 35.96 ± 0.45°C, p < 0.001) and minimum (36.09 ± 0.35°C vs. 35.58 ± 0.58°C, p < 0.001) core temperatures. Extubation time was shorter (5.12 ± 2.31 min vs. 9.69 ± 8.27 min, p < 0.001), PACU temperature was higher (p = 0.001), postoperative fever incidence was lower (0% vs. 13.6%, p = 0.006), and HLOS was reduced (10.02 ± 3.87 vs. 11.63 ± 4.25 days, p = 0.034). No significant differences were observed in infection rate or hospitalization cost. Conclusion:The intelligent closed-loop warming system effectively prevents perioperative hypothermia and enhances postoperative recovery in VATS patients. It provides precise thermal regulation and better clinical outcomes, supporting its application in perioperative temperature management.

Delayed emergence from anesthesia is a common perioperative complication in elderly patients undergoing video-assisted thoracoscopic surgery (VATS), which may lead to prolonged recovery and increased healthcare burden. However, predictive tools specifically developed for this population remain limited. This study aimed to develop and validate a practical model to identify patients at increased risk of delayed emergence from anesthesia. This retrospective study included 1,400 elderly patients who underwent video-assisted thoracoscopic surgery (VATS) at a tertiary hospital in Beijing between January 2020 and April 2026. An additional temporally independent cohort of 300 patients was used for temporal validation. Perioperative variables, including baseline characteristics, comorbidities, intraoperative parameters, and laboratory indicators, were collected. Predictors were selected using least absolute shrinkage and selection operator (LASSO) regression, followed by multivariable logistic regression to construct the model. A nomogram was developed and internally validated using 1,000 bootstrap resamples. Model performance was assessed using discrimination, calibration, decision curve analysis (DCA), and temporal validation with subgroup analyses. Delayed emergence occurred in 210 patients (15.00

Traumatic brain injury (TBI) is a major cause of long-term neurological disability worldwide, and effective therapeutic strategies remain limited. Cottonseed oil (CSO), a plant-derived oil rich in polyunsaturated fatty acids, has been reported to exert protective effects in ischemia-related injuries; however, its role and underlying mechanisms in TBI remain unclear. Here, we established a controlled cortical impact (CCI) model in mice and administered CSO by oral gavage prior to injury. Neurological function was assessed using the modified neurological severity score, rotarod, and balance beam tests, and neuronal injury was evaluated by histological and biochemical analyses. CSO administration significantly improved neurological and motor function, attenuated neuronal damage and apoptosis, enhanced cerebral blood perfusion, preserved blood-brain barrier (BBB) integrity, and reduced brain edema. CSO modulated the expression of AQP4, VEGFA, and BDNF, and markedly suppressed glial activation and pro-inflammatory cytokine production. In vitro, CSO alleviated H2O2-induced cellular injury in HT22 cells by reducing reactive oxygen species accumulation and restoring antioxidant defenses. Mechanistically, the neuroprotective effects of CSO were associated with activation of the AKT/GSK-3β signaling pathway, characterized by enhanced phosphorylation of AKT (Ser473) and inhibitory phosphorylation of GSK-3β (Ser9). Pharmacological inhibition of AKT with MK2206 abolished CSO-induced AKT/GSK-3β pathway activation, reduced cell viability, and restored the elevation of IL-1β and IL-6 levels in vitro, confirming that the anti-neuroinflammatory effects of CSO are mediated at least in part through the AKT/GSK-3β signaling axis. Collectively, these findings demonstrate that CSO exerts significant neuroprotective effects in experimental TBI by preserving neurovascular integrity, attenuating neuroinflammation, and activating the AKT/GSK-3β pathway, highlighting CSO as a promising preventive strategy for TBI.

The oculocardiac reflex (OCR) is the most common complication in pediatric strabismus surgery, and its main clinical manifestation is bradycardia. Esketamine can activate the sympathetic nervous system, leading to an indirect cardiovascular stimulation effect, which results in increased blood pressure and a faster heart rate. The aim of this study is to explore whether a sub-anesthetic dose of esketamine can effectively inhibit the oculocardiac reflex during strabismus surgery. This prospective, single-center, randomized, double-blinded trial will enroll 204 pediatric patients undergoing strabismus surgery. Participants will be randomly assigned to esketamine (group S) and control groups (group C) in a 1:1 ratio. Esketamine (0.2 mg/kg) or an equal volume of normal saline will be administered after anesthesia induction. The OCR is defined as a sudden decrease in heart rate (HR) of 20 www.chictr.org.cn . Prospectively registered.

OBJECTIVE:Pulmonary embolism (PE) after surgery is a severe thrombotic event for patients suffering from head and neck malignancies. Our study analyzed the factors related to PE in such patients following radical resection. A case-control study was designed to retrospectively investigate the factors associated with the increased risk. METHODS:From 2013 to 2022, 5042 radical resections were performed for head and neck malignancies. A control group, matched by age, gender, pathological diagnosis, and cancer stage, but without postoperative PE, was selected in a one-to-three ratio. The perioperative clinical data, encompassing hemodynamic management metrics, were subjected to univariate analyses. Conditional logistic regression modeling was implemented to quantify covariate effects. RESULTS:The prevalence of PE after surgery was 0.75% (95% CI = 0.55-1.03). Multivariable conditional logistic regression revealed PE after surgery was associated with cumulative time of the mean blood pressure (MBP) reductions > 20% (OR = 3.167, 95% CI = 1.651-6.075, p = 0.001), oliguria (OR = 44.055, 95% CI = 2.356-823.886, p = 0.011), and bilateral neck dissection (OR = 3.291, 95% CI = 1.112-9.740, p = 0.031). The maximum area under the curve (AUC) for predicting PE was 0.809 (95% CI 0.716-0.902), achieved using cumulative hypotensive burden (MBP reductions > 20%), with a classification threshold of 1.17 h. CONCLUSIONS:Intraoperative hypotension, oliguria, and bilateral neck dissection are significant predictors of postoperative PE following head and neck cancer surgeries. These findings underscore the importance of predictive clinical measures for effective risk control. LEVEL OF EVIDENCE: 3:

Purpose:Perioperative hypothermia, a common complication of general anesthesia, is associated with adverse outcomes. While active warming methods are recommended, the effectiveness of circulating-water mattresses during ophthalmic surgeries remains understudied. This randomized controlled trial assessed whether a circulating-water mattress combined with a cotton quilt (Group W) was superior to a cotton quilt alone (Group C) in maintaining patient body temperature during ophthalmic day-case surgery. Patients and Methods:Group W patients (n=39) used a preheated circulating-water mattress (38°C) on the operating table and were covered with a cotton quilt (from their entry to the operating room until they returned to the ward). Group C patients (n=38) lay on an unheated table and were covered with a cotton quilt. The axillary temperature in the surgical waiting area served as the baseline. Axillary temperature, ambient temperature, heart rate, and mean arterial pressure were documented at anesthesia induction (T0), start of surgery (T1), every 5 min for the first hour (T2-T13), and end of surgery (T14). Satisfaction and thermal comfort scores were assessed at baseline in the waiting area, 5 min before anesthesia induction (t0), 15 min after entering the post-anesthesia care unit (PACU) (t1), and upon leaving the PACU (t2). The primary outcome measure was the axillary temperature at T14. Results:At T14, Group W had a higher axillary temperature than Group C (36.40±0.06°C vs 36.18±0.06°C, P=0.011), with the mean difference 0.22°C, which did not exceed the predefined superiority threshold of 0.30°C, indicating that the warming effect in Group W was not superior to that in Group C. However, thermal comfort and satisfaction scores were significantly enhanced at t0 and t1 (P<0.05). Conclusion:During ophthalmic day-case surgeries, a circulating-water mattress plus a cotton quilt was not superior, regarding their warming effect, but they significantly enhanced patients' thermal comfort and satisfaction.

The connection between perioperative hypothermia and the occurrence of surgical site infections (SSIs) is still not clearly established. This investigation aimed to clarify the potential link between these two factors using meta-analytical techniques. This investigation examined the potential connection of perioperative hypothermia to the risk of SSI. A comprehensive literature review was conducted utilizing PubMed, Web of Science, and Embase. The primary endpoint was the incidence of SSI. Pooled risk ratios were estimated using fixed- or random-effects meta-analysis. Sensitivity analyses were performed to evaluate the impact of preoperative hypothermia on the pooled risk of SSI. Statistical analyses were performed using Review Manager software and R software. Our meta-analysis encompassed 25 studies representing a total of 28,761 patients. The analysis revealed no statistically significant association between patients' intraoperative body temperature and their likelihood of developing post-surgical complications [odds ratio (OR), 1.39; 95

OBJECTIVE:To investigate the current status of hand hygiene practices and knowledge among anaesthesiology personnel in China, providing a reference for improving hand hygiene standards among healthcare workers. METHODS:A cross-sectional nationwide online survey was conducted from 1st November to 31st December 2024, targeting anaesthesiology staff in Chinese hospitals. Developed by a multi-disciplinary team, the questionnaire covered sociodemographics, hand hygiene practices, proficiency and knowledge. Of 2580 responses, 2512 were valid after quality control. Descriptive statistics, Chi-squared tests and logistic regression were used to analyse the data and identify predictors of hand hygiene compliance. RESULTS:The study analysed 2512 valid responses, mostly from male anaesthesiologists (90.84% and 59.39% for males and females, respectively). Most participants were from Class IIIA hospitals (60.67%). A large majority of participants had formal hand hygiene training (94.43%) and regular access to hand sanitizers (90.61%), with over two-thirds reporting adequate disinfection and washing durations (66.44% and 67.27%, respectively) and high adherence to the seven-step technique (81.76%). Barriers to adherence included being 'too busy' (66.28%), insufficient hand towel availability (41.68%), the belief that 'gloves substitute for handwashing' (39.93%), and inadequate facilities (18.91%). The hand hygiene assessment showed a mean knowledge score of 61.02, a mean practice score of 80.36, and a mean proficiency score of 82.62. Higher knowledge and formal training were linked to better compliance with recommended practices. CONCLUSIONS:This study highlights the need for improved hand hygiene practices among anaesthesiology personnel in China, emphasizing the roles of training, knowledge, and addressing barriers to compliance.