BackgroundPhysical activity is a proven intervention for depression and anxiety, but the optimal environment for exercising remains debated. While “green exercise” (in nature) is theorized to offer superior mental health benefits to indoor exercise, a comprehensive quantitative ranking of these modalities against a no-exercise control is lacking. We aimed to determine the comparative efficacy of green exercise, indoor exercise, and control conditions for improving mental health outcomes.MethodsWe conducted a systematic review and network meta-analysis of randomized controlled trials (RCTs). We searched PubMed, Embase, Web of Science, and CENTRAL from inception to December 2024 for RCTs comparing at least two of the following: green exercise, indoor exercise, or a no-exercise/standard care control group in adults. The primary outcome was a composite measure of mental health, including symptoms of depression, anxiety, and psychological distress. A random-effects network meta-analysis was performed to calculate standardized mean differences (SMDs) and rank the interventions using P-scores. The protocol was registered with PROSPERO (CRD420261279222).ResultsFifteen RCTs involving 809 participants were included. The network of evidence formed a closed three-node loop. Compared to control, green exercise showed a large and statistically significant effect on improving mental health (SMD = −0.96, 95% CI: −1.66 to −0.25). Indoor Exercise showed a small, non-significant beneficial trend (SMD = −0.21, 95% CI: −1.08 to 0.67). In direct comparison, green exercise was significantly superior to indoor exercise (SMD = −0.75, 95% CI: −1.32 to −0.18). Ranking analysis confirmed green exercise as the most effective intervention with near certainty (p-score = 0.99). The superior effect of green exercise was maintained in a subgroup analysis of clinical populations.ConclusionGreen exercise is a highly effective intervention for improving mental health, demonstrating benefits significantly greater than both indoor exercise and no-exercise control conditions. These findings strongly support the integration of nature-based physical activity into clinical practice and public health strategies for mental wellness.Systematic review registrationPROSPERO, CRD420261279222.

Persistent pathological pain often induces comorbid depressive-like symptoms, yet the underlying neuronal and molecular mechanisms remain unclear. The nucleus accumbens shell (NAcS) has been implicated in mediating pain sensation and emotional disorders, including depression. However, how it regulates pain-depression comorbidity (PDC) is not well-known. In the present study, we demonstrated that D2-type medium spiny neurons (D2-MSNs) in the NAcS bidirectionally modulated pain and its comorbid behavioral despair measured in the forced swimming test (FST), an effect possibly involving adenosine A2A receptors (A2ARs). Specifically, acute chemogenetic activation of NAcS D2-MSNs induced thermal/mechanical pain in naïve mice but did not affect despair-like behavior in the FST, a phenomenon that occurred after repeated activation of these neurons. Conversely, chemogenetic inhibition of NAcS D2-MSNs alleviated spared nerve injury (SNI) induced neuropathic pain and its comorbid behavioral despair. Our immunofluorescent staining revealed a relatively enriched expression of A2ARs in NAcS D2-MSNs. Ex vivo electrophysiological recordings revealed that activating and inhibiting A2ARs increased and decreased the neuronal excitability of NAcS D2-MSNs. Consistently, local infusion of the agonist and antagonist of A2ARs into the NAcS bidirectionally modulated pain and despair-like behaviors in both naïve and SNI mice. Together, these findings demonstrate the functional role of NAcS D2-MSNs in mediating PDC, which was possibly modulated by local A2ARs, thus providing a potential therapeutic target for PDC.

Background:The depth of sedation during gastrointestinal endoscopy is predominantly assessed based on clinical experience due to the absence of a universally recognized objective standard. This study aimed to evaluate the utility of two novel electroencephalography-derived parameters, the quantitative consciousness index (qCON) and the quantitative nociception index (qNOX), for sedation and analgesia monitoring, and to determine the optimal qCON range correlated with optimal procedural stability. Methods:In this prospective observational study, a total of 220 patients scheduled for elective gastroscopy or colonoscopy were enrolled. All patients received propofol and sufentanil for sedation and analgesia according to routine clinical practice. Depth of anesthesia and nociceptive responses were continuously monitored using qCON and qNOX. Hemodynamic parameters, body movement, and coughing were recorded at predefined time points. The primary outcome was defined as optimal procedural stability, characterized by hemodynamic fluctuations within 10% of baseline combined with the absence of body movement or coughing. Results:A qCON range of 55-63 was observed to be associated with optimal procedural stability (95% confidence interval [CI]: 55.25-62.62 for gastroscopy; 55.25-62.52 for colonoscopy). A strong correlation between qCON and qNOX was observed (gastroscopy: qNOX = 0.78 × qCON + 26.1, R2 = 0.714; colonoscopy: qNOX = 0.83 × qCON + 22.47, R2 = 0.716; p < 0.001). The qNOX index demonstrated a more rapid response to noxious stimuli than qCON during recovery phases. Conclusion:The qCON index appears to provide an objective approach to assessing sedation depth in sedated gastrointestinal endoscopy. Our findings suggest that qCON values within the range of 55 to 63 are associated with optimal procedural stability as defined in this study. Combined monitoring with qCON and qNOX may provide complementary information to support a balanced approach to intra-procedural sedation management, thereby potentially enhancing the safety and overall quality of sedation management. Trial Registration:This study was registered at ClinicalTrials.gov (Registration Number: NCT06604156) on April 11, 2024.

Following the publication of the above article and an Expression of Concern statement that was issued in light of concerns raised by an interested reader (doi: 10.3892/ijo.2025.5816) regarding potential duplications of data comparing Figs. 1D and 2E, and the apparent re‑use of β‑actin control data in Fig. 4A and B where different experimental conditions were reported, the authors have now responded to the enquiry posed by the Editorial Office. After consulting their original data, the authors have realized that the data in Fig. 2E for the MDA‑MB‑231 cell line, and the β‑actin blots in Fig. 4B, were chosen incorrectly (it was also noted by the Editorial Office, upon performing an independent analysis of the data in this paper, that, in Fig. 6C, the CD68/Lep. and CD163/CNL.+Lep. data panels appeared to contain an overlapping section of data, such that the data shown in these panels may have been derived from the same original source). The revised versions of Figs. 2 and 4 (showing the correct data for the MDA‑MB‑231 cell line in Fig. 2E and the β‑actin blots in Fig. 4B) are shown on the next two pages. Furthermore, a revised version of Fig. 6, showing replacement data for the CD68/Lep. data panel, is also shown on the third page. Note that the errors made in assembling these figures did not affect the overall results and conclusions reported in the paper. The authors are grateful to the Editor of International Journal of Oncology for granting them the opportunity to publish this corrigendum, and all the authors agree with its publication; furthermore, they apologize to the readership of the journal for any inconvenience caused. [International Journal of Oncology 48: 2479‑2487, 2016; DOI: 10.3892/ijo.2016.3483].

The purpose of this network meta-analysis was to assess the effect of different active warming strategies on intraoperative hypothermia (IH). Databases of PubMed, Web of Science, Embase, and Cochrane Library were searched for randomized controlled trials that were published from 1 January 2015 to 20 September 2025. The incidence of IH was the primary outcome. A total of 45 studies comprising 5317 patients were included in this study. Among the single warming strategies, both thermal suit [RR = 0.45, 95

Inadvertent intraoperative hypothermia (IOH) significantly increases the risk of complications in elderly patients undergoing general anesthesia. This study aimed to develop and validate a predictive model for IOH specifically for elderly patients in Southwest China. A total of 443 patients aged >= 60 years from 24 hospitals were enrolled and randomly assigned to a derivation cohort (n = 310) and an internal validation cohort (n = 133). Logistic regression, LASSO regression, and random forest models were developed, with internal validation used to select the optimal approach. External validation was performed on 334 patients from 4 participating and 4 non-participating hospitals. In the internal validation, the Logistic Regression model outperformed machine learning algorithms, demonstrating an area under the receiver operating characteristic curve (AUC) of 0.841 (95% CI: 0.772-0.910), with a specificity of 81.48%, sensitivity of 70.21%, and optimal risk threshold of 48%. In the external validation cohort (n = 334), the model maintained robust discriminative ability (AUC: 0.760; 95% CI: 0.703-0.817). Crucially, in a subgroup analysis of patients with normal temperature (>= 36.5 degrees C) at 10 min before anesthesia induction, the model successfully identified 34 high-risk individuals who would likely be overlooked by standard clinical assessment. The Logistic Regression model effectively predicts IOH risk in elderly patients, and a risk probability >= 48% serves as a critical threshold to guide stratified temperature management.

BackgroundInflatable laryngeal mask airway (ILMA) cuff pressure lacks routine monitoring and standardized safe thresholds, with clinical practice often referencing manufacturer specifications. Empirical inflation in clinical practice often leads to overinflation and increased pharyngolaryngeal complications. This study established an individualized ILMA cuff pressure regulation strategy based on physiological characteristics and sealing principles, aiming to compare its effect on postoperative pharyngolaryngeal pain in elderly patients with empirical inflation.MethodsThis single-center, double-blind randomized controlled trial comprised 78 elderly patients undergoing general anesthesia with ILMA. Patients were randomly assigned to either the empirical inflation (EI) group or the individualized regulation and real-time monitoring (RM) group. In group EI, the cuff was inflated empirically. In group RM, individualized regulation and real-time monitoring were applied: cuff pressure was adjusted to maintain ≥ peak airway pressure, with the oropharyngeal leak pressure (OLP) ≥ 25 cmH2O. The primary outcome was the incidence of pharyngolaryngeal pain within 48 h after ILMA removal. The secondary outcomes included other pharyngolaryngeal complications (e.g., supraglottic mucosal injury graded by fiberoptic bronchoscopy), 7-day pulmonary complications assessed by the Postoperative Pulmonary Complications (PPCs) scale and other prespecified secondary outcomes.Results78 elderly patients were randomized, and 74 completed the study. Cuff pressure was significantly higher in group EI than in group RM (p < 0.001), with no between-group differences in ILMA positioning accuracy or ventilation sealing performance (p > 0.05). Group RM had a lower incidence of pharyngolaryngeal pain (7.7% vs. 35.9%, p = 0.003) and mucosal injury (0% vs. 15.4%, p = 0.011) compared with group EI. The reduction in postoperative pain was mainly observed during the early postoperative period.ConclusionIn elderly patients undergoing ILMA-assisted general anesthesia, empirical inflation may result in unnecessarily high cuff pressure. Individualized cuff pressure regulation can reduce postoperative pharyngolaryngeal pain and mucosal injury without compromising ventilation seal integrity, and may represent a feasible strategy to optimize ILMA management in elderly patients.Clinical trial registrationClinicalTrials.gov, identifier NCT06954857.

BACKGROUND:Intraoperative hypothermia is associated with adverse maternal and neonatal outcomes. However, the relationship between obesity and intraoperative hypothermia remains contentious. The aim of this study was to investigate the association between obesity and intraoperative hypothermia in women undergoing caesarean delivery. MATERIALS AND METHODS:We prospectively recruited 705 women who underwent caesarean delivery. Patients were classified into two groups according to body mass index (BMI): non-obese group (BMI < 28 kg/m2) and obese group (BMI ≥ 28.0 kg/m2). The primary outcome measure was the incidence of intraoperative hypothermia, defined as a core temperature of less than 36°C. Intraoperative core temperature was measured in the bladder. Propensity score-matched analyses, multivariable logistic regression analyses, subgroup analyses, and restricted cubic splines were used to assess the association between obesity and intraoperative hypothermia. RESULTS:After propensity score matching, 244 matched pairs were selected for analysis. Participants in the obese group exhibited a significantly lower incidence of hypothermia compared to those in the non-obese group (27.5% vs. 38.9%; P < 0.01). The incidence of need for rescue warming was lower in the obese group compared to the non-obese group (1.2% vs. 5.3%; P = 0.01). Similar findings were observed in the overall study population, the obese group was associated with a significantly decreased incidence of hypothermia when compared to the non-obese group (OR, 0.59; 95% CI, 0.41-0.83; P = 0.03). There was a non-linear association between BMI and hypothermia, with the lowest risk at a BMI of 28.4 kg.m-2. CONCLUSIONS:Obesity was associated with a potentially lower risk and severity of intraoperative hypothermia compared with non-obese patients. Although a non-linear relationship between the degree of obesity and hypothermia was observed, the clinical significance of more severe obesity on hypothermia risk remains to be clarified.

Following the publication of the above paper, it was drawn to the Editor's attention by a concerned reader that the first two lanes of the Actin blot in Fig. 1D looked strikingly similar to the Actin panels in Fig. 2E for the MDA‑MB‑231 cell line, In addition, the Actin panel in Fig. 4A (showing a time series) looked very similar to the Actin panel in Fig. 4B (showing different treatments). Upon analyzing the data independently in the Editorial Office, it came to light that there was an overlapping pair of data panels for the immunohistochemical data shown in Fig. 6C, such that data which were intended to show the results from differently performed experiments appeared to have been derived from the same original source, and data featured in Fig. 6D had subsequently appeared in a paper published in the journal Tumor Biology that was written by different authors at different research institutes. The authors were contacted by the Editorial Office to offer an explanation for these possible anomalies in the presentation of the data in this paper, although up to this time, no response from them has been forthcoming. Owing to the fact that the Editorial Office has been made aware of potential issues surrounding the scientific integrity of this paper, we are issuing an Expression of Concern to notify readers of this potential problem while the Editorial Office conitnues to investigate this matter further. [International Journal of Oncology 48: 2479‑2487, 2016; DOI: 10.3892/ijo.2016.3483].

Background: The assessment of sedation depth during painless gastrointestinal endoscopy primarily relies on clinical experience due to the lack of a universally accepted objective standard. This study aimed to investigate the application of novel electroencephalography-derived indices, the quantitative consciousness index (qCON) and the quantitative nociception index (qNOX), for monitoring sedation and analgesia, and to determine the optimal qCON range associated with stable procedural conditions. Methods: This prospective observational preliminary study enrolled 220 patients undergoing elective gastroscopy or colonoscopy. All patients received propofol and sufentanil for anesthesia. Depth of anesthesia and nociception were continuously monitored using qCON and qNOX. Hemodynamic parameters, body movements, and cough reflexes were recorded at predefined time points. The primary outcome was optimal sedation quality, defined as hemodynamic fluctuations within 10% of baseline and the absence of body movement or coughing. Results: The optimal qCON range associated with stable hemodynamics and absence of noxious responses was 55～63 (95% CI: 55.25–62.62 for gastroscopy; 55.25–62.52 for colonoscopy). Strong correlations were observed between qCON and qNOX (gastroscopy: qNOX = 0.78 × qCON + 26.1, R² = 0.714; colonoscopy: qNOX = 0.83 × qCON + 22.47, R² = 0.716; p < 0.001). The qNOX index demonstrated a faster response to noxious stimuli compared to qCON during both induction and recovery phases. Conclusion: The qCON index provides an objective guidance for sedation depth during painless gastrointestinal endoscopy. Maintaining qCON within the range of 55 to 63 is associated with optimal procedural conditions. The combined use of qCON and qNOX monitoring can help optimize the balance between sedation and analgesia, potentially improving the safety and quality of endoscopic sedation. Trial registration Trial registration: This study was registered at ClinicalTrials.gov (Registration Number: NCT06604156). The registration was completed on April 11, 2024.

Background Postoperative hypotension is a common symptom in elderly patients undergoing total knee arthroplasty (TKA), which is associated with intraoperative blood pressure (BP) management. The study aimed to explore the causes of perioperative hypotension in TKA elderly patients and analyze the effects of BP management strategies based on non-invasive heart function monitoring on reducing postoperative hypotension. Methods A total of 176 elderly TKA patients were divided into four groups: the tourniquet group (Group T), the non-tourniquet group (Group N), the goal-oriented BP management tourniquet group (Group GT), and the goal-oriented BP management non-tourniquet group (Group GN). Patients in Groups T and GT received TKA with a tourniquet. The BP of patients in Groups GT and GN was maintained based on non-invasive heart function monitoring. The mean arterial pressure (MAP), index of cardiac contractility (ICON), stroke volume (SV), and other circulatory indicators were measured using the non-invasive cardiometer monitor at five time points, including before anesthesia (T1), after anesthesia (T2), after completion of the osteotomy (T3), after suturing (T4), and after leaving the post-anesthesia care unit (T5). The frequency of postoperative hypotension within 24 hours was recorded, and the incidence of hypotension was calculated. Results The ICON, SV, and MAP were lower in Groups N and GN than in Groups T and GT at T3 (P < 0.05). The ICON, SV, and MAP were lower in Group N than in Groups GN at T4 and T5 (P < 0.05), and no significant difference was observed between Groups T and GT (P > 0.05). The incidence of postoperative hypotension within 24 hours was higher in Group N (47.1%) (P = 0.007) than in Group GN (21.6%), Group T (19.4%), and Group GT (14.8%). Conclusions Postoperative hypotension in elderly patients undergoing TKA with a non-tourniquet was associated with decreased myocardial contractility. Enhancing myocardial contractility based on non-invasive cardiac function monitoring reduced the incidence of postoperative hypotension.

Propofol can partly ameliorate electroconvulsive shock (ECS)-induced learning and memory impairment by restoring synaptic plasticity. However, the exact mechanism is unknown. Microglia exert different immune functions by regulating their glucose metabolism, which is closely related to synaptic plasticity. We aimed to investigate whether the mechanism underlying the cognitive enhancement effects of propofol is associated with microglial glucose metabolism. Rats depression model was established by chronic unpredictable mild stress (CUMS). Sucrose preference test (SPT) and open field test (OFT) were used to detect anhedonia and anxiety-like behaviors in rats, respectively. Morris water maze (MWM) was used to evaluate the spatial learning and memory ability of rats. Transmission electron microscopy, immunofluorescence, enzymatic activity assays, Western blotting, and RT-qPCR were employed to evaluate hippocampal synaptic structural integrity, microglial glucose metabolism, and the expression of glycolytic regulators p-AMPK/AMPK and HIF-1α. The AMPK inhibitor compound C was used for reverse validation. Propofol attenuated the ECS-induced reduction of hippocampal synaptic proteins PSD-95 and SYN1, suppressed the upregulation of pro-inflammatory cytokines TNF-α and IL-1β, and reduced microglial activation. It also reduced the key glycolytic enzymes in microglia, increased AMPK expression, and decreased HIF-1α expression, thereby improving learning and memory impairment in ECS-treated rats. Compound C reversed propofol's neuroprotective effect. ECS-induced learning and memory deficits in depressive-like rats are associated with increased microglial glycolysis via the AMPK/HIF-1α pathway, a metabolism process that could be mitigated by propofol.

Vitamin C (VitC) has elicited considerable interest regarding its potential role in cancer therapy; however, its effects on tumor immunity remain unclear. In colorectal cancer (CRC), although anti-PD-1/PD-L1 therapies demonstrate promise, their efficacy is still constrained. Our prior research demonstrated that VitC can inhibit tumor growth by suppressing the Warburg effect. This study aims to explore the effects of high-dose VitC on PD-L1 expression in CRC, focusing on its underlying mechanisms and potential for enhancing immunotherapy. We found that VitC inhibits aerobic glycolysis in HCT116 cells while also downregulating PD-L1 expression. Further investigations indicated that this process is mediated by VitC's activation of AMPK, which downregulates HK2 and NF-κB, ultimately resulting in reduced PD-L1 expression and increased T cell infiltration. Notably, we observed that VitC and the PD-L1 monoclonal antibody atezolizumab exhibit comparable tumor-inhibiting abilities, and their combined use further enhances this efficacy. In conclusion, our results demonstrate that high-dose VitC activates AMPK, downregulates PD-L1 expression, mitigates immune evasion, and suppresses tumor growth. This provides a promising strategy for optimizing immunotherapy in CRC.

Electroconvulsive therapy (ECT) is recognized as one of the most efficacious interventions for depression. However, it is associated with impairments in learning and memory functions. Ketamine has demonstrated potential in mitigating cognitive deficits. Notably, the metabotropic glutamate system is hypothesized to play a pivotal role in cognitive process regulation. Nevertheless, the involvement of the metabotropic glutamate system in esketamine-mediated alleviation of electroconvulsive shock (ECS, an animal analogue of ECT)-induced memory impairment remains to be elucidated. In this study, a depressive rat model was established using chronic unpredictable mild stress. The depressive-like behavior and cognitive performance of the rats were evaluated using the sucrose preference test, the open field test, and the Morris water maze test, respectively. The expression levels of type-5 metabotropic glutamate receptor (mGluR5) and N-methyl-d-aspartate receptor 1 (NMDAR1) were quantified through immunofluorescence and real-time PCR techniques. Long-term potentiation (LTP) of hippocampal Schaffer collateral (SC)-CA1 synapses was observed in electrophysiological experiments. The results of this investigation revealed that a low dose of esketamine administration upregulated the expression of mGluR5 and NMDAR1 in the hippocampus of stressed rats, alleviated ECS-induced cognitive impairment, and ameliorated depressive-like behavior. Conversely, the mGluR5 antagonist MTEP effectively reversed esketamine-mediated changes in the rat hippocampus and counteracted its protective effect on learning and memory functions following ECS. In conclusion, the findings of this study support the hypothesis that esketamine upregulates mGluR5 and NMDAR1 expression, thereby enhancing NMDAR activation in the hippocampus. This mechanism may be responsible for the protective effects on spatial learning and memory function observed in depressed rats subjected to ECS.

Mitochondrial dysfunction is closely associated with cancer development. Colorectal cancer (CRC) cells often exhibit altered energy metabolism, characterized by increased glycolysis and reduced oxidative phosphorylation. Enhancing mitochondrial biogenesis and function may represent a promising therapeutic approach. High-dose vitamin C has demonstrated anti-tumor properties and the ability to reverse the Warburg effect, but its role in regulating mitochondrial biogenesis and function remains unclear. We evaluated the altered mitochondrial functional status of HCT116 colorectal cancer cells compared to FHC colorectal epithelial cells, assessed the effects of high-dose vitamin C on mitochondrial biogenesis and function in HCT116 cells, and explored the underlying regulatory mechanisms. HCT116 cells exhibited mitochondrial dysfunction compared to FHC cells, including decreased expression of electron transport chain complexes III and IV, reduced TFAM levels, and lower mtDNA content. Vitamin C treatment significantly enhanced mitochondrial biogenesis and function, as reflected by increased AMPK phosphorylation, upregulation of PGC-1α, SOD2, NRF2, TFAM, MT-CYB, and MTCO1, elevated mtDNA content, restored membrane potential, enhanced oxidative phosphorylation, and reduced glycolytic activity. Furthermore, vitamin C markedly suppressed HCT116 cell viability and clonogenic capacity, while these effects were substantially diminished by cotreatment with Compound C. This study demonstrates that high-dose vitamin C ameliorates mitochondrial dysfunction and promotes mitochondrial biogenesis and function in colorectal cancer cells through activation of the AMPK–PGC-1α signaling pathway, thereby suppressing tumor cell proliferation. These findings suggest that vitamin C may serve as a promising therapeutic agent for targeting mitochondrial metabolism in colorectal cancer.

Previously, it has been shown that obesity may be considered as a risk factor for breast cancer in postmenopausal women. Leptin, a hormone whose level is elevated in obesity, has been suggested to be involved in the development of breast cancer, and univariate survival analyses have shown that over-expression of ACAT2, an enzyme that is involved in the production of cholesteryl esters, may be associated with a poor prognosis. Here, we aimed to investigate the effect of leptin on the proliferation, migration and invasion of breast cancer cells, as well as to elucidate its underlying mode of action.

Summary Introduction Conflicting results have been reported regarding the influence of BMI on postoperative adverse events. The aim of this study was to investigate the association between BMI and postoperative pulmonary complications in adults undergoing non‐cardiac, non‐obstetric surgical procedures. Methods This large‐scale retrospective study included 125,082 adults who underwent surgery at a university‐affiliated tertiary care hospital between 2019 and 2023. The primary endpoint was the incidence of postoperative pulmonary complications. Multivariable logistic regression analyses, subgroup analyses, sensitivity analyses and restricted cubic splines were used to assess the association between BMI and postoperative pulmonary complications. Results A total of 6671 patients (5.3%) developed one or more postoperative pulmonary complications. After adjusting for confounders, compared with those patients with a normal weight (BMI 18.5–24.9 kg.m ‐2 ), patients who were underweight (BMI < 18.5 kg.m ‐2 ) had an increased risk of postoperative pulmonary complications (OR 1.24, 95%CI 1.12–1.39, p < 0.001). Patients who were overweight (BMI 25.0–29.9 kg.m ‐2 ) or living with class 1 obesity (BMI 30.0–34.9 kg.m ‐2 ) had a lower risk of postoperative pulmonary complications (OR 0.88, 95%CI 0.83–0.94, p < 0.001 and OR 0.82, 95%CI 0.70–0.96; p = 0.01, respectively). Patients living with obesity class 2/3 (BMI ≥ 35 kg.m ‐2 ) had a similar risk of postoperative pulmonary complications as patients with a normal weight (OR 1.23, 95%CI 0.91–1.66, p = 0.17). There was a J‐shaped association between BMI and incidence of postoperative pulmonary complications with the lowest risk at a BMI of 27.4 kg.m ‐2 . Discussion Patients who were overweight or living with class 1 obesity undergoing non‐cardiac, non‐obstetric surgery had paradoxically lower risks of postoperative pulmonary complications compared with those of a normal weight. These findings may contradict traditional assumptions about surgical risk and obesity, highlighting the need to re‐evaluate the relationship between BMI and postoperative pulmonary complications.

COVID-19 infectious is still a widely prevalent disease today. Although most patients with COVID-19 infection are mild. Some patients still develop to post-COVID-19 conditions, significantly increasing the perioperative cardiovascular risks. To better assess and prevent the perioperative cardiovascular risks of patients with COVID-19 infection, the safety and effectiveness of clinical practice can be improved through comprehensive measures, such as medical history collection, detection of symptoms and signs, application of auxiliary examinations, selection of scales and related rehabilitation treatment.

Electroconvulsive therapy (ECT) is an effective treatment for depression, and esketamine has been shown to have antidepressant effects. However, it is currently unclear whether adjunctive esketamine can enhance the clinical efficacy of ECT in real-world clinical practice. In this pragmatic clinical trial, patients with major depression were randomly assigned into two groups: patients received 0.25mg/kg esketamine plus propofol (esketamine group) or the same volume of saline (control group) plus propofol. Results indicated that there was no difference in response and remission rates between the two groups. However, patients receiving esketamine had a higher remission rate of SI and lower psychotic scores. Patients receiving esketamine also required a lower electric dose, but the seizure duration and cognitive function were comparable between the two groups. Diastolic blood pressure increased after esketamine injection, but there was no increased risk of hypertension. Furthermore, incidence of delirium and confusion were comparable between the groups. Conclusively, adjunctive esketamine anesthesia does not provide any advantage in improving the response and remission rates of ECT. However, it can improve remission of SI and alleviate accompanying psychotic symptoms in depressive patients. With adjunctive usage, the adverse cardiovascular and neuropsychiatric events associated with esketamine appear to be tolerable.

BACKGROUND Electroconvulsive therapy (ECT) is both an effective treatment for patients with major depressive disorder (MDD) and a noxious stimulus. Although some studies have explored the effect of sedation depth on seizure parameters in ECT, there is little research on the noxious stimulation response to ECT. In this study, we used two electroencephalography (EEG)-derived indices, the quantitative consciousness (qCON) index and quantitative nociceptive (qNOX) index, to monitor sedation, hypnosis, and noxious stimulation response in patients with MDD undergoing acute ECT. AIM To evaluate the effect of anesthesia depth based on the qCON and qNOX indices on seizure parameters. METHODS Patients with MDD (n = 24) underwent acute bilateral temporal ECT under propofol anesthesia. Before ECT, the patients were randomly divided into three groups according to qCON scores (qCON60-70, qCON50-60, and qCON40-50). Continuous qCON monitoring was performed 3 minutes before and during ECT, and the qCON, qNOX, vital signs, EEG seizure parameters, and complications during the recovery period were recorded. The 24-item Hamilton Rating Scale for Depression, Zung’s Self-rating Depression Scale, and Montreal Cognitive Assessment scores were evaluated before the first ECT session, after the fourth ECT session, and after the full course of ECT. RESULTS A total of 193 ECT sessions were performed on 24 participants. The qCON index significantly affected the EEG seizure duration, peak mid-ictal amplitude, and maximum heart rate during ECT (P < 0.05). The qNOX index significantly affected the post-ictal suppression index (P < 0.05). Age, number of ECT sessions, and anesthetic-ECT time intervals also had a significant effect on EEG seizure parameters (P < 0.05). However, there were no significant differences in complications, 24-item Hamilton Rating Scale for Depression scores, Zung’s Self-rating Depression Scale scores, or Montreal Cognitive Assessment scores among the three groups (P > 0.05). CONCLUSION Electrical stimulation at a qCON index of 60-70 resulted in better EEG seizure parameters without increasing complications in patients with MDD undergoing bilateral temporal ECT under propofol anesthesia.