The relationships among intraoperative dexmedetomidine administration, acute postoperative pain, and postoperative neuropsychiatric complications in elderly patients receiving gastrointestinal surgery remain incompletely characterized. This multicenter cohort study analyzed data from the Perioperative Database of Chinese Elderly Patients. The participants who underwent gastrointestinal surgery were divided into two groups: the dexmedetomidine group and the nondexmedetomidine group. The primary outcome was 30-day postoperative neuropsychiatric complications, whereas secondary outcomes included severe pain, surgery-related, respiratory, cardiovascular, and digestive system complications, and acute kidney injury. Propensity score matching balanced the baseline characteristics. Associations between dexmedetomidine and outcomes were assessed via univariate and multivariate logistic regression. Subgroup analyses and mediation analysis were used to evaluate the correlations and relationships among dexmedetomidine, postoperative pain, and neuropsychiatric complications. Multivariate regression was used to examine the dose‒response effects of dexmedetomidine. Of the 1388 eligible patients, 333 (24.0

OBJECTIVES:To evaluate the association between preoperative serum magnesium (sMg) and postoperative acute kidney injury (PO-AKI) risk in elderly noncardiac surgery patients, and to explore the potential mediating role of systemic inflammation measured by C-reactive protein (CRP). METHODS:We conducted a retrospective cohort study including patients aged ≥65 years undergoing elective noncardiac surgery at a tertiary center from 2014 to 2021. Preoperative sMg and CRP were measured within 30 days before surgery. PO-AKI within 7 days postoperatively was defined using Kidney Disease: Improving Global Outcomes criteria. Confounders were selected using a directed acyclic graph. Logistic regression and restricted cubic spline models assessed the association between sMg and PO-AKI, and CRP-mediated effects were evaluated via formal mediation analysis. RESULTS:Among 13,245 patients (median age, 71 years; 45.6% male), 884 (6.7%) developed PO-AKI. A U-shaped relationship was observed between preoperative sMg and PO-AKI risk. Compared with patients in the fourth quintile (0.90-0.95 mmol/L), those in the lowest (≤0.83 mmol/L) and highest (>0.95 mmol/L) quintiles had 50% and 25% higher odds of PO-AKI, respectively. Mediation analysis indicated that CRP partially explained this association, accounting for 14.35% of the total effect, with higher contributions in cancer patients and younger elderly individuals. CONCLUSIONS:Deviations from the optimal preoperative sMg range, particularly lower levels, were associated with an increased risk of PO-AKI in elderly surgical patients, whereas high-normal levels conferred a modest relative risk elevation. Systemic inflammation partially mediated these associations, suggesting that preoperative sMg assessment may help identify vulnerable patients and inform perioperative monitoring strategies.

Background Heart block is common in cardiac surgery but understudied in noncardiac settings despite its poor prognosis. Objectives This study aims to investigate epidemiology, develop predictive models, and assess the prognostic value of new-onset heart block after noncardiac surgery. Methods This retrospective study analyzed 281,497 patients from 2008 to 2019. The primary outcome was new-onset heart block within 30 days. We used least absolute shrinkage and selection operator for variable selection and machine learning algorithms (eg, Nnet, LGBM, SVM, and XGB) for prediction. Piecewise Cox regression was used to analyze 1-year survival in elderly patients. Results New-onset heart block occurred in 1,000 of 281,497 patients (0.36%; 95% CI: 0.33%-0.38%). Subtypes included 192 of 281,497 atrioventricular (AV) blocks (0.07%; 95% CI: 0.06%-0.08%); 51 of 281,497 left bundle branch blocks (0.02%; 95% CI: 0.01%-0.02%); and 757 of 281,497 right bundle branch blocks (RBBBs) (0.27%; 95% CI: 0.25%-0.29%). The XGB model achieved a validation area under the curve of 0.804 using 12 predictors. Median follow-up for elderly patients was 162 days (Q1-Q3: 85-256) for nonsurvivors and 365 days (Q1-Q3: 365-365) for survivors. AV block predicted poor early-phase prognosis (adjusted HR: 6.24; 95% CI: 1.83-21.23), whereas RBBB was associated with poor late-phase prognosis (adjusted HR: 2.67; 95% CI: 1.26-5.69). Conclusions New-onset heart block affects 0.36% of noncardiac surgery patients. Machine learning effectively predicts this complication. Given the significant mortality risks associated with AV block and RBBB, enhanced perioperative surveillance is crucial.

Inflammatory bowel disease (IBD) is a chronic and recurrent gastrointestinal disease, the pathogenesis of which has not been fully elucidated. Increasing evidence suggests that the disorder of mitochondrial metabolism is closely related to the pathogenesis of IBD, but its specific regulatory network and key genes remain to be further investigated. IBD-related transcriptome datasets (GSE3365 and GSE75214) and single-cell sequencing dataset (GSE134809) were obtained from the Gene Expression Omnibus database. Differentially expressed genes and hub genes were identified through differential expression analysis and weighted gene co-expression network analysis, and candidate genes were obtained by intersecting these with mitochondrial metabolism-related genes, followed by functional enrichment analysis. Machine learning algorithms were used to screen key genes and construct risk prediction models. Additionally, analysis of GSE134809 single-cell data identified characteristic cell types and expression distribution of key genes in IBD and explored communication between different cell types. Furthermore, immune cell infiltration, competitive endogenous RNA (ceRNA) network, and transcription factor prediction were performed. Finally, the diagnostic performance of key genes was validated in GSE75214 and reverse transcription-quantitative polymerase chain reaction. Two key genes, mitochondrial ribosomal protein L35 (MRPL35) and MRPL39, were identified, which were downregulated in IBD, and had good diagnostic potential. Single-cell analysis revealed that key genes were predominantly highly expressed in mononuclear phagocyte (MNP) cells. MNP cells communicated with other cells through receptor ligands including MIF-(CD74 + CXCR4), MDK-SDC1, and ITGB2-ICAM2, which are complexly related to mitochondrial metabolism. With the progression of IBD, infiltration levels of resting natural killer cells, naive B cells, M2 macrophages, and naive CD4 T cells decreased, and correlations between different cells continuously changed. A ceRNA network centered on XIST, hsa-miR-103a-3p, and MRPL35 was constructed. Additionally, therapeutic drugs targeting key genes were predicted, including cimetidine, eugenol, chlortetracycline, vincristine, irinotecan, bisacodyl, and sulpiride, with molecular docking validating high affinity between these drugs and key targets. This study constructed a multiomics integrated analysis strategy and identified MRPL35 and MRPL39 as potential markers and therapeutic targets, providing new insights for the diagnosis and treatment of IBD.

BACKGROUND:Postoperative delirium (POD) is a common complication in elderly patients. This study aimed to investigate the association between preoperative anticholinergic drug burden and POD in elderly patients. METHODS:This nested case-control study included patients aged ≥ 65 years who underwent general anesthesia between April 2020 and April 2022 at multiple hospitals in China. POD occurring within 7 days postoperatively was assessed using the 3-Minute Diagnostic Interview for Confusion Assessment Method. Preoperative anticholinergic drug burden was quantified using the Anticholinergic Cognitive Burden (ACB) scale. Univariate and multivariate logistic regression models with random effects were used to determine the association between ACB scores and POD occurrence. Kaplan-Meier survival analysis with log-rank tests was plotted to compare the cumulative POD incidence across groups. Subgroup analyses were performed to explore the relationship between ACB scores and POD occurrence within specific populations. RESULTS:Among 10,296 patients, 1131 (11.0%) developed POD. The study employed a 5:1 matched case-control design and included 1125 cases and 5296 matched controls. Univariate (odds ratio [OR]: 1.230; 95% confidence interval [CI]: 1.119-1.353, p < 0.001) and multivariate (adjusted OR: 1.118; 95% CI: 1.006-1.243, p = 0.037) analyses demonstrated a significant association between higher anticholinergic drug burden and increased POD risk. When analyzed categorically (ACB score 0 as reference), adjusted ORs were 1.100 (95% CI: 0.919-1.317; p = 0.296) for ACB = 1, 1.213 (95% CI: 0.831-1.771; p = 0.318) for ACB = 2, and 1.963 (95% CI: 1.253-3.076; p = 0.003) for ACB ≥ 3. Kaplan-Meier analysis demonstrated a significantly higher cumulative incidence of POD in the ACB ≥ 3 group (log-rank p < 0.001), with divergence starting on postoperative day 3. CONCLUSION:A higher preoperative anticholinergic drug burden is associated with an increased risk of POD in elderly patients, particularly when the ACB scores are ≥ 3.

OBJECTIVES:To investigate whether preoperative cardiology consultation reduces the incidence of major adverse cardiac events (MACE) in patients undergoing non-cardiac surgeries. METHODS:This cohort study was conducted among 7019 elderly patients (above 65 years) with abnormal ECGs undergoing non-cardiac surgeries. The main outcome was MACE occurrence within 30 days post-surgery. The patients were divided into model development and validation cohorts in a 7:3 ratio, and each cohort was categorized into two subgroups with high-risk and low-risk abnormal ECG. MACE prediction models were constructed for the subgroups, and their predictive power was evaluated using ROC curves; the value of preoperative cardiology consultation for reducing MACE was assessed using decision curve analysis. RESULTS:Among the 4914 patients in the model development cohort, 61 of the 3010 patients with low-risk abnormal ECGs experienced MACE (2.0%), as compared with 59 out of 1904 patients (3.1%) in the high-risk group. The predictive model for MACE for the low-risk group contained 6 risk factors (AUC=0.772), and that for the high-risk group contained 5 risk factors (AUC=0.769). In patients with low-risk abnormal ECG, undergoing cardiovascular specialist consultation did not show significant benefits (the survival rate for predicting MACE was 0.02). However, in patients with high-risk abnormal ECG and those with low-risk abnormal ECG but having specific risk factors, undergoing cardiovascular specialist consultation showed significant benefits with survival rates for predicting MACE of 0.3 and 0.229, respectively. CONCLUSIONS:For patients with high-risk abnormal ECG and those with low-risk abnormal ECG and specific risk factors, preoperative cardiology consultation may help to reduce the occurrence of MACE following non-cardiac surgeries, but for patients with simple low-risk abnormal ECG cases without risk factors, preoperative cardiology consultation can be omitted, which does not affect the incidence of MACE but can improve medical efficiency.

Postoperative delirium (POD) and acute kidney injury (AKI) are serious complications in older patients undergoing surgery, yet predictive model development is often constrained by single-center data limitations and privacy concerns that preclude centralized data sharing. To address these challenges, we retrospectively evaluated a simulated federated learning (FL) framework using multicenter datasets partitioned by hospital source, without sharing raw patient data across centers. A total of 7,216 non-cardiac, non-neurosurgical patients aged 65 years or older were included across five centers, with four contributing training data and one serving as an external validation site. Using a multilayer perceptron architecture, we implemented three federated algorithms and benchmarked them against local learning models (LLMs) and centralized learning models (CLMs). For POD, federated learning models (FLMs) achieved internal area under the curve (AUC) values of 0.725-0.726 and external AUCs of 0.700-0.701. For AKI, internal AUCs reached 0.780 and external AUCs ranged from 0.740 to 0.741. FLM performance was statistically comparable to CLMs (p > 0.05). These findings support federated learning as a feasible privacy-preserving strategy that achieved discrimination comparable to centralized learning for multicenter prediction of postoperative complications in older patients.

Background Cardiovascular-kidney-metabolic (CKM) syndrome represents a complex interplay among obesity, metabolic dysfunction, kidney disease, and cardiovascular disease. The relationship between CKM staging and myocardial injury after noncardiac surgery (MINS) has not been comprehensively studied. Objectives This study sought to investigate the association between the CKM syndrome and MINS risk in patients undergoing noncardiac surgery. Methods This single-center retrospective cohort study included 25,040 patients aged ≥45 years who underwent noncardiac surgery between January 2019 and December 2023. Patients were classified according to CKM stages 0 to 4. MINS was defined as postoperative troponin elevation with ischemic etiology within 30 days. Four progressive multivariable logistic regression models were constructed, and subgroup analyses were performed stratified by age, sex, and surgery type. Results Among 25,040 patients (median time to MINS: 2.0 days [IQR: 0.8-6.6]), CKM stages 0 to 4 comprised 13.0%, 15.0%, 43.7%, 18.7%, and 9.7%, respectively. MINS occurred in 1,782 patients (7.12% [6.80-7.44]), demonstrating a J-shaped distribution: lowest in stage 1 at 141 of 3,754 (3.76% [3.19-4.41]), intermediate in stages 0 (166 of 3,246, 5.11% [4.40-5.93]) and 2 (586 of 10,943, 5.36% [4.94-5.80]), and highest in stages 3 (512 of 4,670, 10.96% [10.09-11.90]) and 4 (377 of 2,427, 15.53% [14.14-17.04]). With stage 0 as reference, stages 3 (OR: 1.95 [1.60-2.37]) and 4 (OR: 2.16 [1.75-2.66]) independently predicted increased MINS risk (both P < 0.001), with significant age interaction (P = 0.013) showing stronger associations in younger patients. Conclusions Advanced CKM stages independently predicted an increased risk of MINS. These findings may improve perioperative risk assessment and guide preventive strategies.

Background:Postoperative delirium (POD) is a common and severe complication in older surgical patients. Although systemic inflammation and frailty are established risk factors, the predictive value of the lymphocyte-to-monocyte ratio (LMR) across different frailty strata remains unclear. This study aimed to evaluate the association between preoperative LMR and POD and to determine whether this relationship varies according to frailty status. Methods:We performed a retrospective analysis of prospectively collected data from a multicenter cohort of 6,475 patients aged ≥65 years undergoing elective non-cardiac, non-neurosurgical surgery in China. Preoperative LMR was calculated from preoperative blood tests. Logistic regression and restricted cubic spline (RCS) analyses were used to assess the association between preoperative LMR and POD, with further stratified analyses performed across different frailty groups. Results:Among 6,475 patients, 789 (12.2%) developed POD. After adjustment for potential confounders, higher LMR was independently associated with a lower risk of POD (per 1-unit increase: OR 0.94, 95% CI 0.90-0.98, P = 0.009). A significant inverse dose-response relationship was observed. Compared with the lowest quartile (Q1), the adjusted ORs (95% CIs) for Q2-Q4 were 0.73 (0.59-0.90), 0.69 (0.56-0.86), and 0.68 (0.54-0.85), respectively. Stratified analyses revealed distinct patterns across frailty status: a significant nonlinear association was observed only in pre-frail patients (Q4 vs. Q1: adjusted OR 0.69, 95% CI 0.50-0.95; P for nonlinearity = 0.003). In contrast, the association in frail individuals was weaker and primarily linear, while no significant association was observed in robust patients. Conclusion:Preoperative LMR is independently associated with POD in older surgical patients. Its predictive value varies across frailty strata, with the association most evident among pre-frail individuals.

BackgroundChronic insomnia disorder (CID) is associated with changes in gray matter volume (GMV) and structural connectivity in several brain regions. However, alterations in the topological properties of the structural covariant network (SCN) remain poorly understood in CID.MethodsVoxel-based morphometry and graph theory were applied to examine the topological characteristics of the GMV-based SCN in 82 patients with CID and 73 healthy controls. Group comparison of GMV and multiple regression with pittsburgh sleep quality index (PSQI) were conducted, with hamilton depression acale, hamilton depression scale, total intracranial volume, age, sex, and years of education as covariates. The brain SCN was constructed by thresholding Pearson correlations between the corrected GMVs of 90 brain regions, defined via the automated anatomical labeling atlas. Both the global and nodal topological properties of the brain SCN were analyzed, controlling for the same set of covariates.ResultsThe bilateral precentral gyrus (PreCG) showed both increased GMV and a negative correlation with PSQI scores (p < 0.001, uncorrected). No significant differences were found in the global network topological properties between groups. CID patients exhibited increased nodal betweenness centrality in the right paracentral lobule (PCL), and decreased nodal degree and efficiency in the left postcentral gyrus (PoCG) (p < 0.05, false discovery rate corrected). Furthermore, we observed alterations in both the number and distribution of network hubs. Notably, the constellation of regions exhibiting altered nodal parameters (the right PCL and left PoCG) also functioned as reconfigured network hubs.ConclusionsThis study establishes an association between sleep disturbances in CID and aberrations in both the GMV of specific sensory-motor network nodes (PreCG, PCL, PoCG) and their SCN topological properties, thereby providing new directions for elucidating the disorder’s pathophysiology.

OBJECTIVES:To investigate the association between intraoperative dexmedetomidine administration and postoperative sleep disturbance in elderly patients undergoing noncardiac surgeries. METHODS:This prospective observational study included patients aged ≥65 years undergoing noncardiac surgeries between April, 2020 and April, 2022 in multiple hospitals. The primary outcome was the incidence of postoperative sleep disturbance within 3 days after surgery, assessed using the Sleep Quality-Numeric Rating Scale. The secondary outcomes included the incidences of sleep disturbance on the night of surgery and two subsequent nights, postoperative severe pain, postoperative delirium, acute kidney injury, stroke and pulmonary infection. Univariate and multivariate logistic regression analyses were conducted to explore the relationship between dexmedetomidine and postoperative sleep disturbance. Propensity score matching was used to balance the baseline characteristics, and subgroup analyses were performed to explore the association between dexmedetomidine and postoperative sleep disturbance. RESULTS:Among the 5245 patients, 1352 (25.78%) developed postoperative sleep disturbance within 3 days after surgery. The incidence of postoperative sleep disturbance was significantly lower in dexmedetomidine group than in the non-dexmedetomidine group (unadjusted: 21.0% vs 27.9%, P<0.001; PSM: 20.7% vs 25.4%, P<0.001). Dexmedetomidine was significantly associated with a reduced risk of postoperative sleep disturbance (unadjusted: OR=0.69, 95% CI: 0.60-0.79, P<0.001; Model I: OR=0.76, 95% CI: 0.66-0.87, P<0.001; Model II: OR=0.75, 95% CI: 0.65-0.87, P<0.001; PSM: OR=0.77, 95% CI: 0.65-0.91, P<0.001), and the association remained significant in subgroup analyses for gender, ASA classification, surgery duration, and surgical types). The incidences of severe postoperative pain, postoperative delirium and pulmonary infection were all significantly lower in dexmedetomidine group. CONCLUSIONS:Intraoperative dexmedetomidine administration is associated with reduced postoperative sleep disturbance in elderly patients undergoing noncardiac surgery and lowers the incidences of severe postoperative pain, postoperative delirium and pulmonary infections.

BACKGROUND:Multiple scales are available to evaluate the health status of older surgical patients; however, their relative ability to predict postoperative major adverse cardiac and cerebrovascular events (MACCE) remains unclear. OBJECTIVE:To examine the association between preoperative health status, as measured by four commonly used scales, and 30-day postoperative MACCE in older surgical patients, and to compare their predictive performance and incremental value against the Revised Cardiac Risk Index (RCRI). DESIGN:A retrospective study of a large multicentre cohort. SETTING:Nineteen tertiary hospitals across China participating in a perioperative database. PATIENTS:Patients aged ≥65 years who underwent noncardiac, non-neurosurgical surgery between April 2020 and April 2022 were included in the analysis. The Activities of Daily Living (ADL), EuroQol Five-Dimension Five-Level (EQ-5D-5L), Metabolic Equivalent of Task (MET), FRAIL, and RCRI were evaluated preoperatively. MAIN OUTCOME MEASURE:The primary outcome was the occurrence of MACCE within 30 days after surgery, defined as any of the following: stroke, myocardial infarction, angina pectoris, congestive heart failure, cardiac arrest, or all-cause mortality. RESULTS:Among the 7996 patients, 126 (1.6%) experienced MACCE. Similar to the RCRI, the four health assessments were significantly associated with MACCE risk. The RCRI alone yielded an area under the curve (AUC) of 0.610 [95% confidence interval (CI): 0.563 to 0.658]. Incorporating each scale improved the predictive performance of the RCRI. The RCRI-Plus model, comprising RCRI, age, severity of anaemia, and surgical duration, achieved an AUC of 0.692 (95% CI: 0.643 to 0.741). Further addition of the four scales to the RCRI-Plus increased discrimination, with the highest AUC observed for the RCRI-Plus model incorporating FRAIL (AUC 0.724; 95% CI: 0.679 to 0.770). However, DeLong's test showed no significant differences between this model and the RCRI-Plus models incorporating ADL, EQ-5D-5L, or MET. CONCLUSIONS:Preoperative health status assessed by four geriatric scales was significantly correlated with postoperative MACCE and provided improved risk discrimination beyond the RCRI. Adding any of these assessments to the RCRI enhanced predictive performance, with FRAIL showing the greatest incremental benefit. These findings underscore the value of multidimensional health status evaluation for preoperative cardiac and cerebrovascular risk stratification, with frailty assessment warranting particular attention. TRIAL REGISTRY:ClinicalTrials.gov, NCT04911530.

Extreme cold causes myocardial injury; however, cold acclimation (CA) enhances myocardial tolerance. This study investigated whether brown adipose tissue (BAT)-derived extracellular vesicles (BAT-EVs) contribute to CA-induced cardioprotection. Mice were subjected to CA or acute cold stress. Cardiac function was assessed using echocardiography and biomarkers. Interscapular BAT (iBAT) ablation has confirmed the necessity of iBAT. EVs were characterized and tested in HL-1 cardiomyocytes. Transcriptomics and specific gene knockdowns have identified key molecular mechanisms. CA preserved cardiac function and integrity under -25°C stress, and these effects were abolished by iBAT ablation. EVs from CA mice mediate this protection by mitigating cardiomyocyte apoptosis. Mechanistically, lncRNA Morrbid was enriched in iBAT and serum EVs after CA. iBAT-specific Morrbid knockdown significantly attenuates EV-mediated protection. Furthermore, Morrbid was associated with upregulation of Serpine1 in cardiomyocytes; silencing Serpine1 abolished anti-apoptotic benefits. This study identified a BAT-Heart axis where CA stimulates the release of Morrbid-enriched EVs. These vesicles serve as a mechanism to confer remote cardioprotection, potentially by upregulating cardiac Serpine1 and suppressing apoptosis.

BACKGROUND:Midazolam is a short-acting benzodiazepine frequently used in the perioperative setting. This study aimed to investigate the potential impact of intraoperative midazolam on postoperative delirium in older patients undergoing noncardiac surgery. METHODS:This study included patients aged 65 yr and older who received general anesthesia between April 2020 and April 2022 in multiple hospitals across China. Postoperative delirium occurring within 7 days was assessed using the 3-min Diagnostic Interview for Confusion Assessment Method. Univariable and multivariable logistic regression models based on the random effects were used to determine the association between midazolam administration and the occurrence of postoperative delirium, presented as the risk ratio and 95% CI. A Kaplan-Meier cumulative incidence curve was plotted to compare the distribution of time to postoperative delirium onset between patients who received midazolam and those who did not. Subgroup analyses based on specific populations were performed to explore the relationship between midazolam and postoperative delirium. RESULTS:In all, 5,663 patients were included, of whom 723 (12.8%) developed postoperative delirium. Univariate and multivariable logistic regression analyses based on random effects of different hospitals showed no significant association between midazolam medication and postoperative delirium among older population (unadjusted risk ratio, 0.96; 95% CI, 0.90 to 1.30; P = 0.38; and adjusted risk ratio, 1.09; 95% CI, 0.91 to 1.33; P = 0.35). The Kaplan-Meier curve showed no difference in the distribution of time to postoperative delirium onset (hazard ratio, 1.02; 95% CI, 0.88 to 1.18; P = 0.82). The results of subgroup analyses found that intraoperative midazolam treatment was not associated with postoperative delirium in the specific subgroups of patients. CONCLUSIONS:Intraoperative administration of midazolam may not be associated with an increased risk of postoperative delirium in older patients undergoing noncardiac surgery.

Objective:To identify the association between preoperative inflammatory state and myocardial injury after noncardiac surgery (MINS) in older patients using systemic inflammation indicators neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) and to compare their clinical predictive values. Methods:This study included patients aged ≥65 years who underwent noncardiac surgery between January 2017 and August 2019. The relationship between preoperative inflammatory state and MINS was investigated using univariate and multivariate logistic regression analyses. The predictive values of NLR, PLR, and SII were determined by receiver operating characteristic (ROC) curve analysis. Based on the basic model we constructed, the predictive values were compared through separately adding NLR, PLR and SII. Results:Among 12464 patients, 965 (7.74%) developed MINS. The optimal cut-off values of NLR, PLR, and SII were 597×109, 2.59, and 923. Univariate and multivariate analyses show that preoperative inflammatory state is associated with MINS. In the multivariate analysis, the OR values for NLR, PLR, and SII were (OR: 1.61, 95% CI: 1.36-1.89, p<0.001), (OR: 1.28, 95% CI: 1.07-1.52, p=0.006), and (OR: 1.43, 95% CI: 1.20-1.70, p<0.001). ROC curve analysis indicated that NLR was more predictive of MINS (area under the curve [AUC]: 0.671, 95% CI: 0.652-0.689) than PLR (AUC: 0.635, 95% CI: 0.616-0.655) and SII (AUC: 0.648, 95% CI: 0.628-0.667). The addition of the NLR to a basic prediction model improved its predictive ability to a greater extent than the addition of PLR and SII. Conclusion:Higher preoperative inflammation levels are associated with an increased risk of MINS. The NLR, PLR, and SII are independent risk factors for MINS and NLR demonstrated better predictive value than that of PLR and SII.

To develop and externally validate a risk prediction model for postoperative acute kidney injury (PO-AKI) in elderly patients undergoing noncardiac surgery, addressing the current gap in predictive tools for this vulnerable population. A multicenter retrospective cohort study presented according to TRIPOD + AI statement. Conducted in 21 tertiary hospitals across 11 provinces in China from January 2009 to April 2022. Elderly patients (≥ 65 years) undergoing noncardiac procedures. The endpoint was PO-AKI within seven days post-surgery, diagnosed using the KDIGO criteria. Data were extracted from electronic medical records for model derivation and validation. The study included 163,131 elderly patients, with 52,494 for model discovery, 7,899 and 80,641 for external validation. The model incorporated nine variables: age, heart disease history, preoperative hyponatremia, renal surgery (yes/no), surgery type, surgery duration, intraoperative diuretics usage, first-aid vasopressors usage, and blood transfusion. The model demonstrated acceptable discriminative ability with AUROC values of 0.803, 0.793, 0.770, and 0.774 across the training, internal validation, and two external validation datasets, respectively. The calibration plots and decision curve analyses yielded commendable results in both training and validation sets. To streamline usability, we employed risk scores and categorized the population into low-, medium-, and high-risk subgroups. Clinicians could implement this externally validated risk prediction model to stratify PO-AKI risks in elderly patients during the early postoperative phases of noncardiac surgery.

Background:Intraoperative hypotension (IOH) is an important risk factor for major adverse cardiac events (MACE) in patients undergoing noncardiac surgery. However, the IOH threshold in older adult patients remains controversial. Objective:This study aimed to explore an appropriate IOH threshold in older adult patients to decrease the risk of MACE. Methods:This study involved older adult patients undergoing noncardiac surgery (age ≥65 y) from January 2012 to August 2019 in the Chinese People's Liberation Army General Hospital (PLAGH; 35,262 patients) and Shanghai Changhai Hospital from January 2024 to December 2024 (13,418 patients). Univariate moving-average plots and multivariate restricted cubic splines were used to determine the IOH thresholds associated with an increased risk of MACE. The relationship between the IOH threshold and MACE was assessed using univariate and multivariate logistic regression analyses by 3 different hypotension exposure forms (duration, area, and time-weighted average mean arterial pressure [MAP]). Results:Out of 35,262 patients, 874 developed MACE in PLAGH, and 296 of 13,418 patients developed MACE in Changhai Hospital. In PLAGH, MAP below an absolute threshold of 70 mm Hg was associated with MACE. When the IOH absolute threshold was 70 mm Hg, the risk of MACE demonstrated a "dose-increasing" effect with changes in IOH exposure, and the risk of MACE was significantly increased when the duration lasted >15 minutes (odds ratio 1.51, 95% CI 1.22-1.88; P<.001). The stratified analysis showed that in patients younger than 80 years, when intraoperative MAP dropped below 70 mm Hg for more than 15 minutes, the odds ratio was 1.38 (95% CI 0.86-2.28), P<.01. In Changhai hospital, intraoperative MAP <70 mm Hg was also significantly associated with MACE. Furthermore, IOH lasting longer than 15 minutes substantially increased the risk of MACE. Conclusions:For older adult patients undergoing noncardiac surgery, intraoperative MAP should be kept above 70 mm Hg to reduce the risk of postoperative MACE.

The impact of fatty liver disease on lumbar bone mineral density (BMD) represents an intriguing area of study, particularly in light of established research linking obesity to bone metabolism. However, there remains limited investigation into the correlation between quantifying liver fat content (LFC) and lumbar BMD among overweight and obese populations, particularly within the Chinese demographic. This study aims to accurately quantify LFC and investigate its association with lumbar BMD in overweight or obese individuals. This cross-sectional study was conducted at the Health Management Center of Henan Provincial People’s Hospital from January 2019 to February 2023, involving 6996 participants with a body mass index (BMI) of 24 kg/m² or higher. LFC and lumbar BMD were assessed using computed tomography. The study utilized one-way ANOVA, subgroup analysis, multifactor regression analysis, smooth curve fitting, and threshold and saturation effect analysis to explore the relationship between LFC and lumbar BMD. Furthermore, inflammatory cell analysis was included to investigate the potential mediating role of inflammatory cells in the association between LFC and lumbar BMD. After adjusting for confounding variables, multivariate regression analysis revealed a significant negative association between LFC and lumbar BMD (β = −0.323, 95