Perioperative stress is an unavoidable part of surgery and may be particularly relevant in patients with cancer. Surgical trauma activates two major stress pathways, the hypothalamic–pituitary–adrenal (HPA) axis and the sympathetic nervous system (SNS), leading to surges in stress hormones, inflammatory mediators, and a temporary reduction in anti-tumor immune function. This sequence can be described as a stress–inflammation–immunosuppression axis. Experimental studies suggest that excessive activation of this axis may support postoperative survival and spread of residual tumor cells, yet clinical outcome data remain inconsistent and often depend on cancer type, stage, and the overall perioperative care bundle. This review integrates mechanistic evidence on how perioperative stress and inflammation reshape immune surveillance, including effects on natural killer (NK) cells, cytotoxic T lymphocytes, myeloid-derived suppressor cells (MDSCs), regulatory T cells (Tregs), and neutrophil extracellular traps (NETs). We also summarize how commonly used anesthetic drugs and techniques may modify stress signaling, inflammation, and immune function, and we critically appraise the current clinical evidence linking anesthetic management to biomarkers and oncologic outcomes. Finally, we propose an executable framework for individualized anesthetic planning that focuses on reducing stress peaks, limiting avoidable physiologic instability, supporting early recovery, and shortening the postoperative window of immunosuppression within enhanced recovery pathways.

BackgroundSepsis carries high ICU mortality globally, often requiring sedated mechanical ventilation. While some studies suggest dexmedetomidine improves survival in these patients, others contradict this finding. This study evaluates dexmedetomidine’s survival benefit and sedation value for ventilated sepsis cases.MethodsThis retrospective cohort study utilized the MIMIC-IV database and eICU-CRD to analyze mechanically ventilated septic patients. Propensity score matching was employed to balance covariates. Machine learning algorithms were applied to validate dexmedetomidine’s role in predicting mortality.ResultsA propensity score matching analysis was performed for 5176 pairs of patients. The use of dexmedetomidine was associated with a reduced risk of 28-day mortality (13.39% vs. 19.84%, HR: 0.595, P < 0.001) and of 180-day all-cause mortality (17.45% vs. 23.18%, HR: 0.632, P < 0.001). However, dexmedetomidine use was also associated with longer hospital (median 15.08 days vs. 10.2 days, P < 0.001) and ICU stays (median 6.81 days vs. 4.0 days, P < 0.001). Moreover, the duration of mechanical ventilation was significantly longer in the dexmedetomidine group (median 78 h vs. 51.00 h, P < 0.001). Dexmedetomidine was included among the significant features identified with the Boruta algorithm, and of the five machine learning models built using the 20 most important features (including dexmedetomidine), the model constructed on the basis of the Random Forest algorithm performed the best (training set: AUC = 0.781; test set: AUC = 0.811; eICU-CRD set: AUC = 0.820). SHapley Additive exPlanations (SHAP) revealed that comorbid acute kidney injury (AKI) was the most important predictor of mortality among mechanically ventilated septic patients. This was followed by the use of opioids, PaO2, and the SOFA score, with the use of dexmedetomidine relatively closely behind.ConclusionsDexmedetomidine use significantly reduces short-term mortality in mechanically ventilated patients with sepsis but prolongs the hospital and ICU length of stay (LOS) and duration of mechanical ventilation. Administering dexmedetomidine within 48 hours and maintaining an infusion rate at or below 0.6 μg/kg/h appears to be more beneficial. Moreover, dexmedetomidine use strongly influences mortality in these patients.

Background Oliceridine, a novel biased μ-opioid receptor agonist, is widely used perioperatively, yet limited data exists regarding its impact on postoperative quality of recovery. This study investigated the effect of oliceridine-based patient-controlled intravenous analgesia (PCIA) on postoperative quality of recovery among patients undergoing laparoscopic gynecological tumour resection.Methods Ninety‑four female patients scheduled for elective laparoscopic gynecological tumour resection were included. Patients were randomized to two groups: oliceridine group (loading dose 1.5 mg, PCIA 0.55 mg/kg) or sufentanil group (loading dose 10 μg, PCIA 3 μg/kg). The primary outcome was the Quality of Recovery-40 (QoR-40) score on postoperative day 1. The secondary outcomes included the QoR-40 score, the numeric rating scale (NRS) pain score, the Hospital Anxiety and Depression Scale-Anxiety (HADS-A) score, the Fatigue, Resistance, Ambulation, Illness and Loss of weight (FRAIL) index and adverse events within 3 postoperative days.Results Higher QoR-40 scores were found in the oliceridine group on postoperative day 1 (182.9 ± 3.1 versus 177.5 ± 3.9, p < 0.001). Compared with the sufentanil group, the oliceridine group showed better QoR-40 scores within 3 days after operation. No significant differences were observed in NRS pain scores or HADS-A scores between the two groups (all p > 0.05). However, the median FRAIL score in the oliceridine group was lower on postoperative day 2 (p = 0.018).Conclusion Oliceridine used in PCIA improves early postoperative recovery quality of patients undergoing laparoscopic gynecological tumour resection. It provides analgesic effect comparable to sufentanil and lowers incidences of postoperative frailty, nausea and vomiting.Trial Registration Chinese Clinical Trial Registry, ChiCTR.org.cn, identifier: ChiCTR2400094271.

OBJECTIVES:The primary aim is to identify pancreatic parenchymal imaging markers of fibrosis in children with chronic pancreatitis (CP). Secondary aims include describing the pattern of histopathologic fibrosis in different pancreatic regions and examining the impact of fibrosis on exocrine pancreatic insufficiency (EPI) and baseline glycemic status. METHODS:Single-center cross-sectional study that included children aged 0-21 years who underwent total pancreatectomy islet auto-transplantation (TPIAT) before December 2022. Those with prior pancreatic surgeries, missing imaging, or missing histology were excluded. RESULTS:Ninety-five patients (56% female, median age 13.3 y) were included. Multiple parenchymal imaging variables were significantly associated with histologic pancreatic fibrosis. A 5 mL decrease in segmented pancreas volume [odds ratio (OR)=1.2, 95% CI: 1.1-1.4, P <0.05] and a 0.1 unit decrease in T1 signal intensity ratio (SIR) pancreas/spleen ( P /s) (OR=1.7, 95% CI: 1.2-2.2, P <0.05) had increased fibrosis odds. A multivariable model with pancreas volume and T1 SIRp/s predicted severe fibrosis with an area under the receiver operating characteristic curve (AUROC) of 0.8 (95% CI:0.7-0.9). Histologic fibrosis scores showed substantial agreement between pancreatic sampling locations (kappa=0.7, 95% CI: 0.6-0.9). EPI by fecal elastase (FE-1) was associated with increased odds of severe fibrosis (OR=11.7, 95% CI: 2.5-54.1, P <0.05) and higher Ammann scores were seen in participants with prediabetes and diabetes [9.0, interquartile range (IQR): 8.0-12.0, P =0.08]. CONCLUSIONS:The pancreatic parenchyma provides insights into pediatric CP through fibrosis assessment, which correlates with pancreatic function. A predictive model using pancreas volume and T1 SIR shows promise for forecasting pancreatic parenchymal fibrosis in children with CP.

BACKGROUND:Antroduodenal (ADM) and colonic (CM) manometries are performed in pediatric patients to evaluate gastrointestinal motility disorders. While minimal standards for performing ADM and CM have been published, there are no standardized protocols for performance of these studies. We aimed to evaluate the diversity in ADM and CM protocols in pediatric centers worldwide. METHODS:A cross-sectional study using an anonymous survey was conducted among pediatric centers worldwide comparing US and non-US centers. RESULTS:Responses were received from 37 pediatric centers. ADM: 17 (45.9%) centers perform next-day and 14 (37.8%) centers perform same-day studies. Study length ranges from 4 to 24 hours. Erythromycin stimulation is implemented by 29/33 (87.9%), azithromycin by 15/33 (45.5%) and octreotide by 7/33 (21.2%) centers. US centers perform more pharmacological stimulations (30/31 (96.8%) vs. 3/6 (50%), p = 0.0018), while non-US centers conduct longer studies (15.3 hours vs. 7.4 hours, p = 0.0291). CM: 17 (45.9%) centers perform same-day studies with length from 4 to 24 hours, and 89.2% perform pharmacological stimulation, all using bisacodyl. CONCLUSIONS:Significant variability exists in ADM and CM protocols among pediatric centers, affecting study length and pharmacological stimulation. Universal standardized guidelines are needed to ensure uniformity in the performance and interpretation of these studies. IMPACT:Pediatric gastroenterological societies set minimal standards for antroduodenal (ADM) and colonic (CM) manometry studies, allowing variability in timing, fasting, postprandial phases, and provocation tests. Protocol variability among pediatric centers worldwide has not been previously assessed. This study offers a real-life overview of ADM and CM practices in pediatric centers worldwide, highlighting the need for standardized guidelines due to observed variability in timing, duration, and pharmacologic stimulation. The lack of standardization affects study interpretation and underscores the importance of developing universal guidelines.

Acute lung injury significantly contributes to mortality in bacterial sepsis due to lung endothelial barrier destruction, leading to protein-rich lung edema, an influx of proinflammatory leukocytes, and persistent hypoxemia. CTRP3, an adipokine, reduces endothelial adhesion molecules Vcam-1 and Icam-1 and inhibits LPS-induced monocytic adhesion, highlighting its anti-inflammatory effects. This study investigates CTRP3's protective role in sepsis-induced acute lung injury, revealing reduced CTRP3 expression during sepsis, which worsens endothelial dysfunction. Supplementing with recombinant CTRP3 mitigates this dysfunction and reduces LPS-induced endothelial pyroptosis by inhibiting caspase-1, thus protecting the endothelial barrier and reducing lung injury. In conclusion, CTRP3 preserves endothelial function in sepsis by suppressing pyroptosis.

INTRODUCTION:The optimal first-line treatment of pediatric achalasia remains debated. Pneumatic balloon dilation (PD) shows variable success and low complication rates in small cohorts. To evaluate the efficacy and safety of PD as first-line therapy for pediatric achalasia. METHODS:A retrospective review (2011-2022) of patients aged younger than 21 years treated at a single center was conducted. Success was defined as no additional intervention within 12 months. RESULTS:Of 23 patients (median age 13 years), 78% had success at 12 months; 74% maintained success at 30 months. No major complications occurred. DISCUSSION:PD is a safe, effective first-line treatment of pediatric achalasia.

BACKGROUND:The impact of Dexmedetomidine (Dex) use on the prognosis of patients with ventilator-associated pneumonia (VAP) remains a subject worthy of further investigation. This study seeks to evaluate the association between Dex administration and prognosis in critically ill patients with VAP. We conducted a retrospective cohort study using the MIMIC-IV database, including adults (≥ 18 years) with VAP and ICU stays ≥ 24 h. Patients were divided into the DEX group and the non-DEX group based on Dex administration. The primary endpoint was in-hospital mortality, and the secondary endpoint was 90-day survival rate. We used multivariable logistic regression and propensity score matching (PSM) to adjust for baseline imbalances. Kaplan-Meier analysis assessed survival differences. Stratified analyses evaluated temporal trends (2008-2022), dosage (mcg/kg/h), and infusion duration (hours) to further validate the robustness of the results. This research included a total of 1766 VAP patients (DEX: n = 905; non-DEX: n = 861), Dex was associated with reduced in-hospital mortality (unadjusted OR 0.55, 95% CI 0.44-0.69; adjusted OR 0.62, 95% CI 0.47-0.83).The survival curve was calculated based on Kaplan-Meier analysis, which indicated that the DEX group exhibited a relatively longer survival time, and this difference was highly statistically significant (p < 0.001).It is worth mentioning that the mortality reduction remained robust across all sensitivity analyses, including PSM, temporal stratification, and dose-duration subgroups. Dex is associated with significantly lower in-hospital mortality in VAP patients.

OBJECTIVE:This study explored infection risk factors within one month post-kidney transplantation (KT) and developed a clinical prediction model. METHODS:We retrospectively analyzed clinical data from KT patients treated at our hospital (January 2015-December 2024). Patients were categorized into infection or control groups based on 1-month postoperative infection status. Infection incidence and risk factors were analyzed, and a multivariate logistic regression model was developed. The receiver operating characteristic (ROC) curves and a nomogram were generated. Patients were randomly split 7:3 into training and validation sets to assess model performance. RESULTS:A total of 410 patients were included in this study, of whom 131 had postoperative infection, with an incidence rate of 31.95%. Multivariate logistic regression analysis showed that history of smoking (odds ratio (OR) = 2.96, 95% confidence interval (CI) (1.20-7.27)), drainage tube indwelling time (OR = 1.41, 95% CI (1.17-1.71)), catheter indwelling time (OR = 1.66, 95% CI (1.36-2.03)) and albumin (ALB) (OR = 0.78, 95% CI (0.71-0.86)) and haemoglobin (HGB) (OR = 0.70, 95% CI (0.59-0.83)) levels were independent risk factors for early infection after KT (p < 0.05). The area under the ROC curve of the training set was 0.954 (95% CI (0.925-0.982)), the specificity was 0.855 and the sensitivity was 0.896. In the validation set, the area under the ROC curve was 0.914 (95% CI (0.861-0.967)), the specificity was 0.832 and the sensitivity was 0.903. The Hosmer-Lemeshow goodness-of-fit test of the model showed that the training set χ2 = 6.962 (p = 1.000) and the validation set χ2 = 8.813 (p = 0.450). Multivariate risk factors were used to construct a nomogram model, and the calibration curve was consistent with the ideal curve, suggesting that the model had good stability. The clinical decision curve showed that it had good clinical value. CONCLUSIONS:History of smoking, drainage tube indwelling time, catheter indwelling time and ALB and HGB levels are the risk factors of infection after KT. The model based on these factors can effectively predict the occurrence of infection after KT.

BACKGROUND & AIM:To investigate the yet unexplored links between maternal and offspring outcomes of pregnancy metabolic dysfunction-associated steatotic liver disease (MASLD). METHODS:Prospective observational study using magnetic resonance imaging with proton density fat fraction (MRI-PDFF) to determine the presence of maternal and offspring liver steatosis during gestation (3rd trimester) and in the first year postpartum. Women were deemed at high or low risk for MASLD if they had risk factors (pre-pregnancy obesity or MASLD, gestational diabetes, rapid weight gain during pregnancy). Multivariable regression and longitudinal mixed models assessed associations and changes in MRI-derived fat measures. RESULTS:We recruited 57 pregnant women; 47 (82 %) were high-risk for MASLD. MASLD was seen in 18 % (n = 10) of women (and 15 % [n = 7/47] of those high-risk), with a median PDFF of 5.9 % (IQR: 5.6-12.0 %). Maternal weight, BMI and HDL-C differed between groups. The fetal liver and placental PDFF of offspring of women with and without MASLD were not different. N = 7 (12 %) infants had clinically significant steatosis in utero, all offspring of mothers without gestational MASLD. Of the 30 mothers with repeat liver MRI-PDFF at 9 months postpartum, ten (33 %)had MASLD. N = 44 infants followed up at either 3 or 9 months of age, with only one still demonstrating significant steatosis 9 months. No infant exposed to gestational MASLD had significant steatosis in the first year. CONCLUSIONS:Gestational MASLD is generally mild, but hepatic fat fraction increases postpartum. Clinically significant hepatic steatosis occurs as early as in utero but is not associated with maternal MASLD.