Lupus retinopathy (LR) is a sight-threatening complication of systemic lupus erythematosus (SLE), yet disease-specific serologic biomarkers are lacking. Previous studies have shown that anti-recoverin (RCV) antibodies act as a biomarker of cancer-associated retinopathy and serum level of anti-RCV antibodies was elevated in SLE patients with fundus abnormalities. This study screened three candidate epitopes of RCV protein and evaluated anti-RCV epitope-specific autoantibodies as candidate serological markers for LR. The epitopes of RCV protein were predicted by DNAStar software and cross-checked by BepiPred-2.0 and ABCpred. Serum autoantibodies against RCV and three linear epitopes (RCV55–70, RCV139–154, RCV155–170) was determined by ELISA in SLE patients with LR (n = 48), without LR (non-LR, n = 48), and healthy controls (HC, n = 44). Statistical analyses included the Kruskal–Wallis with Dunn’s post-hoc tests, Mann-Whitney U test, Student’s t test, Chi-Square or Fisher’s exact tests, correlation analysis, logistic regression, and ROC analysis. Epitope-specific anti-RCV antibodies were significantly higher in LR than in non-LR SLE and HC (all p < 0.05). Anti-RCV139–154 demonstrated the highest diagnostic performance for identifying LR from SLE, with an AUC of 0.808 (95

Background: The identification of difficult laryngoscopy is a critical skill for anesthesiologists, particularly in high-risk procedures such as cervical spine surgery, which demands heightened accuracy in preoperative airway assessment. This study developed a deep learning algorithm, the double-pose feature clustering network (DPFCNet), designed to improve the identification of patients with difficult laryngoscopy through comprehensive analysis of neutral and extended cervical spine x-ray images. Methods: In this prospective cohort study, 14,407 patients who underwent elective cervical spine surgery under general anesthesia (July 2016 to July 2023) were initially enrolled. Following rigorous screening, 1,568 participants were eligible and included in the analysis, comprising 319 difficult laryngoscopy cases and 1,249 easy laryngoscopy cases. The study evaluated the effectiveness of a deep learning model for identifying difficult laryngoscopy that was developed using a ResNet-based feature extraction module with dual-position image fusion technology and systematically compared it against conventional bedside assessments using area under the receiver operating characteristic curve (AUC) analysis. Results: Conventional clinical indicators showed poor predictive capacity for difficult laryngoscopy: thyromental distance (AUC = 0.594), neck circumference (AUC = 0.662), inter-incisor gap (AUC = 0.607), and modified Mallampati test (AUC = 0.624). Their combination achieved AUC = 0.743. In contrast, DPFCNet considerably outperformed conventional methods with AUC = 0.866, demonstrating superior discriminative power. Conclusion: This study employed a deep learning model for the comprehensive analysis of both neutral and extended cervical spine x-ray images, considerably improving the prediction accuracy of difficult laryngoscopy. DPFCNet provides an effective decision-support tool for preoperative risk stratification in cervical spondylosis patients.

Renal denervation (RDN) is a catheter-based interventional approach that targets renal sympathetic nerves to modulate sympathetic overactivity, a key pathophysiological driver of resistant hypertension and associated cardiovascular complications. In contrast to pharmacological approaches, the therapeutic effect of RDN does not rely on patient adherence. Originally indicated for severe resistant hypertension, RDN has since shown consistent antihypertensive efficacy across a broad range of hypertensive patients in recent sham-controlled studies. In this review, we discuss the pathophysiological foundation underlying RDN, consolidate the current clinical evidence supporting its therapeutic efficacy, describe the spectrum of available ablation technologies, and evaluate its expanding applications in conditions driven by sympathetic overactivity.

The post anesthesia recovery phase following bariatric surgery is a high-risk period characterized by increased susceptibility to respiratory and hemodynamic complications, warranting prolonged monitoring and targeted interventions. Despite advancements in perioperative care, the identification of risk factors for extended recovery remains a critical unmet need in obese populations. This single-center retrospective study analyzed 169 consecutive patients undergoing laparoscopic sleeve gastrectomy for metabolic syndrome and extubated in post anesthesia care unit (PACU) at Peking University Third Hospital (2015–2025). Patients were stratified by PACU length of stay (LOS) into extended (≥ 42 min, 75th percentile) and control (< 42 min) groups. Comprehensive perioperative variables were evaluated, including ‌preoperative data of demographic profiles, American Society of Anesthesiologists (ASA) physical status, higher body mass index (BMI), obesity surgery mortality risk score (OS-MRS), and obstructive sleep apnea syndrome (OSAS) comorbidity; ‌Intraoperative and postoperative‌ data including procedure duration, hypoxemia incidence, pain scores, rate of postoperative nausea and vomiting, number of rescue antiemetic administered, postoperative complications, reoperation rates, length of hospital stay, 30-day readmission rates and mortality. Univariate analysis and binary Logistic regression analysis were performed to find the risk factors of prolonged LOS. The extended PACU-LOS group (n = 45, 26.6

This study aimed to explore the efficacy and safety of remimazolam vs. propofol for sedation during video laryngoscopy in cervical spondylosis patients with suspected difficult laryngoscopy. In this single-center, prospective, randomized controlled study, 85 patients with Modified Mallampati class III or IV and limited cervical spine mobility were recruited and randomly assigned (1:1 ratio) to receive either remimazolam or propofol sedation. The primary outcome was the incidence of hypoxemia (SpO₂< 90

BackgroundThe optimal ropivacaine concentration for ultrasound-guided pericapsular nerve group (PENG) block to relieve spinal anesthesia positioning pain in elderly patients with femoral intertrochanteric fracture remains unclear. We aimed to estimate the minimum effective concentration (MEC) and explore concentration-related motor impairment.MethodsIn this double-blind biased-coin up-and-down study, elderly patients scheduled for spinal anesthesia underwent ultrasound-guided PENG block with 20 mL ropivacaine. The initial concentration was 0.10%. For a successful block, the subsequent patient was assigned to the same concentration (probability = 0.89) or a 0.05% lower concentration (probability = 0.11). For a failed block, the concentration was increased by 0.05% for the next patient. The trial was terminated when 45 successful blocks were achieved. Block success was defined as a pain score ≤ 3 at rest and during passive leg raise 30 min after block. The primary outcome was MEC90 estimated by isotonic regression. Secondary outcomes included MEC50, concentration-specific success rates, quadriceps weakness, and onset time of analgesia.ResultsFifty-two patients completed the sequential trial. Isotonic regression estimated MEC90 at 0.25% (95% CI, 0.20%−0.30%) and MEC50 at 0.20% (95% CI, 0.20%−0.20%). Success rates were 0% at 0.10% and 0.15%, 89.5% at 0.20%, 96.0% at 0.25%, and 100% at 0.30%. Quadriceps weakness at 6 h increased with concentration, occurring in 5.3% at 0.20%, 36.0% at 0.25%, and 50.0% at 0.30% (trend P = 0.007; risk ratio comparing high- with low-concentration groups, 8.72; 95% CI, 1.21–62.72). This safety comparison was exploratory. No local anesthetic systemic toxicity or serious adverse events were observed.ConclusionsIn elderly patients with femoral intertrochanteric fracture receiving ultrasound-guided PENG block with a fixed 20 mL volume of ropivacaine, the prespecified isotonic regression-estimated MEC90 for relieving spinal anesthesia positioning pain was 0.25%. Exploratory safety analyses suggested that quadriceps weakness at 6 h was more common at concentrations ≥0.25%, but these analyses were underpowered and hypothesis-generating. Future studies should determine whether modifying volume, concentration, or total dose can preserve analgesia while reducing motor impairment.Clinical trial registrationidentifier ChiCTR2500102032.

Spinal anesthesia during cesarean delivery frequently causes maternal hypotension. Early detection of hemodynamic compromise before blood pressure decline could enable timely intervention. This study evaluates the use of serial transthoracic echocardiography (TTE) as a monitoring tool for early detection of hemodynamic fluctuation. To characterize the temporal sequence of hemodynamic changes using serial TTE, with emphasis on the relationship between stroke volume (SV) reduction and subsequent hypotension, and to assess the potential of TTE‑derived parameters as physiological indicators of preload changes. Prospective observational study. Single-center trial. Thirty healthy term pregnant women (ASA I‑II) undergoing elective cesarean delivery under spinal anesthesia. Serial TTE examinations were performed at 13 predefined time points. Left ventricular diameters (LVIDd, LVIDs) were measured and volumes (EDV, ESV) were derived using the Teichholz method, from which stroke volume, cardiac output, cardiac index, and ejection fraction were calculated. Temporal relationship between SV decline and hypotension onset. After spinal anesthesia, left ventricular end-diastolic volume (EDV) decreased by 34.6

Inflammatory activation is involved in the pathogenesis of heart failure (HF). ATPase H+-Transporting Accessory Protein 2 (ATP6AP2) is an auxiliary subunit of the V-ATPase, and its role in HF is not fully understood. To assess the role and regulatory mechanisms and therapeutic potential of ATP6AP2 in HF, we used a cardiac-specific ATP6AP2 conditional knockout (CKO) mouse model and observed spontaneous cardiac dysfunction, myocardial fibrosis and cardiomyocyte apoptosis in mice. Further studies showed that ATP6AP2 promoted stimulator of interferon genes (STING) degradation through the lysosome-dependent pathway. ATP6AP2 knockdown significantly upregulated STING protein levels, activated the STING-TBK1-IRF3 signaling axis, and promoted pro-inflammatory factor expression and cardiomyocyte apoptosis. In mice with myocardial infarction (MI), myocardial overexpression of ATP6AP2 or treatment with H-151 inhibited the activation of the STING signaling pathway, ameliorated cardiomyocyte apoptosis and inflammatory responses, thereby improving cardiac function. In addition, in macrophages treated with conditioned medium from hypoxia-exposed cardiomyocytes, the levels of pyroptosis-related proteins were markedly increased, whereas ATP6AP2 overexpression or STING inhibition reduced pyroptosis. ATP6AP2 likewise attenuates inflammation and pyroptosis caused by hypoxia in cardiac organoids. In conclusion, activating ATP6AP2 could serve as a promising therapeutic option in HF.

OBJECTIVES:To investigate the clinical sub-phenotype (SP) of pediatric acute kidney injury (AKI) and their association with clinical outcomes. METHODS:General status and initial values of laboratory markers within 24 hours after admission to the pediatric intensive care unit (PICU) were recorded for children with AKI in the derivation cohort (n=650) and the validation cohort (n=177). In the derivation cohort, a least absolute shrinkage and selection operator (LASSO) regression analysis was used to identify death-related indicators, and a two-step cluster analysis was employed to obtain the clinical SP of AKI. A logistic regression analysis was used to develop a parsimonious classifier model with simplified metrics, and the area under the curve (AUC) was used to assess the value of this model. This model was then applied to the validation cohort and the combined derivation and validation cohort. The association between SPs and clinical outcomes was analyzed with all children with AKI as subjects. RESULTS:In the derivation cohort, two clinical SPs of AKI (SP1 and SP2) were identified by the two-step cluster analysis using the 20 variables screened by LASSO regression, namely SPd1 group (n=536) and SPd2 group (n=114). The simplified classifier model containing eight variables (P<0.05) had an AUC of 0.965 in identifying the two clinical SPs of AKI (P<0.001). The validation cohort was clustered into SPv1 group (n=156) and SPv2 group (n=21), and the combined derivation and validation cohort was clustered into SP1 group (n=694) and SP2 group (n=133). After adjustment for confounding factors, compared with the SP1 group, the SP2 group had significantly higher incidence rates of multiple organ dysfunction syndrome and death during the PICU stay (P<0.001), and SP2 was significantly associated with the risk of death within 28 days after admission to the PICU (P<0.001). CONCLUSIONS:This study establishes a parsimonious classifier model and identifies two clinical SPs of AKI with different clinical features and outcomes.The SP2 group has more severe disease and worse clinical prognosis.

Minimally invasive coronary artery bypass grafting (MIDCAB) requires effective left lung isolation, yet evidence comparing video-imaging single-lumen tracheal tubes with bronchial blockers (VSLT + BB) and vedio-imaging double-lumen endotracheal tubes (VDLT) remains limited. This randomized controlled trial aimed to: (1) quantitatively compare time efficiency for device placement and lung isolation between VSLT + BB and VDLT; (2) evaluate perioperative airway complications; and (3) assess differential impacts on postoperative recovery, including postoperative sore throat, hoarseness, and Quality of Recovery-15 (QoR-15) scores. In this single-blind randomized controlled trial, 97 MIDCAB patients were allocated to VSLT + BB or VDLT groups. Primary outcomes were tube positioning time; secondary outcomes included total intubation time, oxygenation parameters, hemodynamic variables, and postoperative complications. VDLT exhibited shorter tube positioning time (128 ± 37 vs. 159 ± 58 s; p < 0.001) but longer total intubation time (192 ± 40 vs. 159 ± 58 s; p < 0.001). VSLT + BB demonstrated higher PaO₂ at 10-min post-OLV (226.0 vs. 168.0 mmHg; p = 0.035) with lower airway pressures (p < 0.05). Postoperative sore throat (33

Accurately identifying surgical patients who will have an increase in stroke volume following fluid administration remains challenging when utilizing noninvasive bedside methods. This study aims to compare the value of using ultrasound to measure changes in corrected carotid artery flow time (ΔFTc) with that of using invasive measurements of stroke volume variation (ΔSVV) for assessing volume responsiveness in patients under general anesthesia and mechanical ventilation. A total of 91 patients undergoing elective abdominal surgery under general anesthesia were enrolled in this prospective observational study. Under general anesthesia and mechanical ventilation, the ΔFTc was measured using noninvasive bedside ultrasound, and the ΔSVV was measured using invasive hemodynamic monitoring, both before and after fluid administration. Fluid responders were defined as an increase in stroke volume of ≥ 10 www.chictr.org.cn (ChiCTR2500101114); registered 21 April 2025.

Objective The aim of this study was to investigate the incidence, risk factors and airway management of postoperative haematoma following anterior cervical spine surgery (ACSS).Design A retrospective nested case-control study.Setting A tertiary hospital in China.Participants A total of 13 523 patients within a single-centre longitudinal ACSS cohort were identified from March 2013 to February 2022. Patients with postoperative haematoma after ACSS were enrolled as the haematoma group, and others in the cohort without haematoma were randomly selected as the non-haematoma group by individually matching with the same operator, same gender, same surgery year and similar age (±5 years) at a ratio of 4:1. Subsequently, patients with haematoma were included in a subgroup for analysis.Primary outcome measures Postoperative haematoma and difficult intubation prior to haematoma evacuation.Results The incidence of postoperative haematoma out of all ACSS was 0.4% (55/13 523). A total of 275 patients were enrolled in the study, including 55 patients in the haematoma group and 220 patients in the non-haematoma group. Anterior cervical corpectomy and fusion (ACCF) (OR 2.459; 95% CI 1.302 to 4.642; p =0.006) and the maximum mean arterial pressure (MAP) during recovery (OR 1.030; 95% CI 1.003 to 1.058; p =0.028) were identified as independent risk factors for haematoma. In the subgroup analysis, 29% of patients with haematoma experienced difficult intubation, and retropharyngeal haematoma (OR 10.435; 95% CI 1.249 to 87.144; p =0.030) was identified as an independent risk factor for difficult intubation. Patients with haematoma had longer hospitalisation duration (p <0.001) and greater costs associated with their stay (p <0.001).Conclusion ACCF and elevated maximum MAP during the recovery period were independent risk factors for postoperative haematoma following ACSS. Patients with post-ACSS haematoma are at high risk of a difficult airway, with retropharyngeal haematoma being strongly associated with challenging airway management. Postoperative haematoma was associated with longer hospitalisation duration and greater costs.Trial registration number China Clinical Trial Registry: ChiCTR2400086263.

BACKGROUND:The rising volume of orthopaedic surgeries highlights the importance of optimal postoperative pain management, especially for trauma patients who frequently suffer inadequate analgesia and delayed recovery. This multicenter study aims to evaluate the prevalence of acute postoperative pain and identify contributing factors in traumatic and non-traumatic orthopaedic patients. METHODS:This multicenter study analysed adult orthopaedic surgery patients from the China Acute Postoperative Pain Study between September 2019 and August 2023. Patients with preoperative acute physical injuries requiring surgical intervention were defined as trauma patients. Using multivariate regression, we compared pain outcomes between trauma/non-trauma groups and identified risk factors for moderate-to-severe postoperative pain. RESULTS:Among 10,892 orthopaedic patients (2833 trauma, 8059 non-trauma), trauma patients showed higher rates of moderate-to-severe pain (57.3% vs. 50.1%), experienced more anxiety and helplessness, and had a greater desire for additional pain management than non-trauma patients. Trauma was associated with the development of moderate-to-severe postoperative pain in both uni- and multivariate analyses (p < 0.001). Risk factors for postoperative pain differed: age over 65 years and preoperative chronic pain were significant in non-trauma patients, whereas intraoperative non-opioid analgesics and local anaesthetic infiltration were associated with a decreased incidence of moderate-to-severe postoperative pain in trauma patients. CONCLUSIONS:Over half of orthopaedic surgery patients experienced moderate to severe postoperative pain, with trauma patients reporting higher levels and greater impacts on their activities and emotional state, along with a greater need for additional pain relief. Distinct risk factors for trauma and non-trauma patients highlight the need for personalised perioperative analgesic strategies. SIGNIFICANCE STATEMENT:This study advances perioperative pain management by identifying trauma as an independent risk factor for moderate-to-severe postoperative pain in orthopaedic patients, with distinct risk profiles for trauma and non-trauma subgroups. Trauma patients reported higher pain levels, greater distress and increased analgesic needs. These findings directly inform clinical practice, emphasising the need for personalised, risk-stratified pain management to improve recovery. The results provide an evidence-based framework for optimising analgesia in both trauma and elective orthopaedic surgery.

Objective: To evaluate the short-term efficacy and safety of ultra-low-dose radiotherapy (4 Gy) in patients with indolent B-cell lymphoma. Materials and Methods: A retrospective analysis was conducted on 14 patients with indolent B-cell lymphoma treated with ultra-low-dose radiotherapy at our institution from January 2024 to February 2025. All patients received a total dose of 4 Gy delivered in 2 fractions of 2 Gy each. Primary endpoints included response rate, locoregional failure-free survival (LRFS), and progression-free survival (PFS). Results: The median age at diagnosis was 58 years (range, 32–74). Pathological subtypes included 10 cases of follicular lymphoma (71.4%), with tumors located in the tonsils, parotid gland, lumbar vertebra, and various lymph nodes; and 4 cases of mucosa-associated lymphoid tissue (MALT) lymphoma (28.6%), with tumors located in the orbit, stomach, and duodenum. Disease stage was I–II in 11 patients (78.6%) and III–IV in 3 patients (21.4%). At a median follow-up of 12.4 months (range, 5.5–17.6), complete response (CR) was observed in 35.7% of cases (n = 5), partial response (PR) in 42.9% (n = 6), stable disease (SD) in 14.3% (n = 2), and progressive disease (PD) in 7.1% (n = 1). One-year LRFS and PFS rates were 91.7% and 83.9%, respectively. One patient with stage IV follicular lymphoma had a residual local lesion that initially achieved remission after radiotherapy but experienced local progression at 6 months; subsequent targeted therapy restored tumor remission. Another patient with stage II follicular lymphoma achieved local tumor remission but developed lymph node metastases outside the radiation field. No grade 3 or higher treatment-related toxicities were observed. Conclusion: Indolent B-cell lymphoma demonstrates a high remission rate with ultra-low-dose radiotherapy while significantly reducing treatment-related toxicities. Keywords: ultra-low-dose radiotherapy; mucosa-associated lymphoid tissue lymphoma; follicular lymphoma

Postoperative retropharyngeal hematoma (RH) is a potentially life-threatening complication of anterior cervical spine surgery (ACSS). Difficult intubation frequently arises during airway management in patients with RH, presenting substantial challenges in clinical practice. This retrospective cohort study aimed to (1) identify risk factors linked to RH development after ACSS, and (2) highlight risk factors for difficult intubation within the RH patient group. This retrospective analysis utilized a single-center longitudinal ACSS cohort from March 2013 to March 2024. The RH cohort was defined as patients who developed postoperative RH, while a non-RH control group (4:1 ratio) was established through matching for the same operator, gender, and operative year, with age matched within ± 5 years. Patients with RH were categorized into two groups based on whether they experienced difficulty in tracheal intubation during airway management prior to hematoma evacuation: the difficult intubation group and the non-difficult intubation group. Multivariable analysis identified independent risk factors for RH and difficult intubation. The incidence of postoperative RH following ACSS was 0.25

This study investigated inter-arm systolic blood pressure difference (IASBPD) and mortality risks in 8628 Chinese community residents from an atherosclerosis cohort. IASBPD was calculated by subtracting the systolic blood pressure of the left arm from that of the right arm. Participants were categorized as |IASBPD| <10 mmHg or ≥10 mmHg. These groups were further subdivided into four categories according to specific IASBPD values. The endpoints included all-cause mortality and cardiovascular mortality. Over a median follow-up of 9.87 years, a total of 442 all-cause and 138 cardiovascular deaths were recorded. Compared to |IASBPD| <10 mmHg group, the |IASBPD| ≥10 mmHg group had a 53% increase in all-cause mortality risk (adjusted HR = 1.53, P = 0.002) and a 71% increase in cardiovascular mortality risk (adjusted HR = 1.71, P = 0.021). When comparing specific IASBPD, no significant increase in all-cause mortality risk was observed in the group with a right arm higher ≥10 mmHg (adjusted HR = 1.17, P = 0.507) or in the group with a left arm higher ≤10 mmHg (adjusted HR = 0.90, P = 0.329). Conversely, the left arm higher >10 mmHg group demonstrated a significant 59% increase in the risk of all-cause mortality (adjusted HR = 1.59, P = 0.013). While the association with cardiovascular mortality was not statistically significant in this subgroup, the trend paralleled that observed for all-cause mortality. In conclusion, an elevated IASBPD is significantly associated with all-cause and cardiovascular mortality risks, with higher IASBPD in the left arm showing a stronger link to all-cause mortality risk.

IntroductionAlthough some clinical prognostic parameters and gene expression features have been identified to be associated with the prognosis of diffuse large B cell lymphoma (DLBCL), clinical outcomes of DLBCL remains unpredictable. Lymphocyte subpopulations are considered to be prognostic factors for DLBCL, however due to the small sample size, conflicting views exist.Methods301 newly diagnosed DLBCL patients treated at our center from January 2015 to December 2019 were retrospectively analyzed to explore the relationship of lymphocyte subsets and prognosis prediction.ResultsIn this retrospective single-center study, patients with more severe disease, defined by either advanced Ann Arbor stage or a high-risk IPI score, consistently exhibited significantly lower percentages of CD19+ B cells, CD4+ T cells and CD4+/CD8+ ratio, while percentage of CD8+ T cells were significantly higher. There were no significant differences in percentages of CD3+ T cells and CD16+CD56+ NK cells. Correlation analysis revealed significant associations between lymphocyte subsets and clinical features such as Ann Arbor stage, IPI score, lactate dehydrogenase (LDH), beta-2 microglobulin (b2-MG), Ki-67, age, and neutrophils. Higher percentages of CD19+ B cells, CD4+ T cells, and CD16+CD56+ NK cells, a higher CD4+/CD8+ ratio, and a lower percentage of CD8+ T cells at diagnosis predicted good response after R-CHOP treatment. Multivariate analysis indicated that a low CD4+/CD8+ ratio was independently associated with worse PFS (p=0.049) and showed a trend toward worse OS (p=0.086). Patients were dichotomized into high and low groups using the median value of CD4+/CD8+ ratio, Kaplan-Meier analysis showed that patients with CD4+/CD8+ ratio ≥1.19 had significantly longer PFS and OS compared to those with CD4+/CD8+ ratio <1.19.DiscussionLymphocyte subsets, especially CD4+/CD8+ ratio, could be recommended as a potential prognostic indicator for DLBCL.