Correlation analysis between plasma biomarkers albumin, fibrinogen, and their ratio with postoperative delirium in patients undergoing non-cardiac surgery: a systematic review and meta-analysis.

OBJECTIVES: This meta-analysis aimed to investigate the correlation between plasma biomarkers, such as albumin and fibrinogen, and their ratio with postoperative delirium (POD) in patients undergoing non-cardiac surgery. METHODS: Relevant observational cohort studies were systematically searched in PubMed, EMBASE, CINAHL, and the Cochrane Library databases as of March 2023. This meta-analysis was conducted using RevMan 5.4.1 and Stata 15.0 software. For continuous variables with non-uniform units, the standardized mean difference (SMD) and 95% confidence intervals (CIs) were used; otherwise, the mean difference (MD) and 95% CIs were employed. The Newcastle-Ottawa Scale (NOS) was applied to assess the quality of included literature. RESULTS: Eighteen studies encompassing 7,011 patients were included. The meta-analysis revealed significantly lower albumin levels (sixteen studies, 5,813 patients, SMD = -0.45, 95% CI = -0.64 to -0.26, P < 0.00001, I2 = 80%) and albumin-fibrinogen ratio (AFR) (four studies, 824 patients, MD = -0.62, 95% CI = -0.76 to -0.48, P = 0.56, I2 = 0%) in the delirious group. Conversely, higher fibrinogen concentrations (two studies, 441 patients, MD = 0.13, 95% CI = 0.02 to 0.24, P = 0.69, I2 = 0%) were observed in the delirious group. Due to high heterogeneity in albumin levels (P < 0.00001, I2 = 80%), we conducted a subgroup and sensitivity analysis, and confirmed that the association of albumin levels was not influenced by surgery type, design or delirium evaluation instruments. CONCLUSIONS: Preoperative albumin, fibrinogen and AFR levels were associated with POD, potentially aiding in identifying high-risk patients and playing a key role in preventing POD.

Effect of transcutaneous electrical acupoint stimulation on the quality of postoperative recovery: a meta-analysis.

BACKGROUND: The purpose of the present study was to systematically delve into the efficacy and safety of transcutaneous electrical acupoint stimulation (TEAS) on the quality of recovery after general anesthesia. METHODS: Randomized controlled trials related to TEAS improving postoperative recovery quality were searched in Cochrane Library, Web of Science, Embase, PubMed, CNKI, VIP, Wanfang and Chinese biomedical database from the inception of each database to June 2023. After literature screening and data extraction, Stata15 software was employed for meta-analysis, and the quality of the included literature was evaluated utilizing ROB2. RESULTS: The study included 10 articles involving 2,383 patients in total. The meta-analysis results unveiled that TEAS could improve 24-hour and 48-hour postoperative QoR-40 scores as well as 24-hour postoperative QoR-40 dimension scores [WMD = 8.52, 95%CI (5.12, 11.91), P < 0.001; WMD = 1.99, 95%CI (0.91, 3.07), P < 0.001], emotional state [WMD = 1.38, 95%CI (0.66, 2.09), P < 0.001], physical comfort [WMD = 2.99, 95%CI (1.59, 4.39), P < 0.001], psychological support [WMD = 0.63, 95%CI (0.36, 0.90), P < 0.001], and physical independence [WMD = 0.76, 95%CI (0.22, 1.30), P = 0.006]; pain [WMD = 1.81, 95%CI (0.87, 2.75), P < 0.001]; decrease 24-hour postoperative VAS pain scores [WMD = -0.84, 95%CI (-1.45, -0.23), P = 0.007] and the incidence of postoperative nausea and vomiting [RR = 0.88, 95%CI (0.81, 0.97), P = 0.006; RR = 0.62, 95%CI (0.52, 0.73), P < 0.001]. CONCLUSION: TEAS can improve postoperative QoR-40 scores and the quality of recovery, relieve pain, and decrease the incidence of nausea and vomiting after surgery in patients who underwent general anesthesia. TRIAL REGISTRATION: CRD42023433959.

Laryngeal mask airway combined with bronchial blocker achieved 1-lung ventilation in a patient with bilateral vocal cord paralysis: A case report.

INTRODUCTION: One-lung ventilation (OLV) is a commonly used technique to facilitate surgical visualization during thoracic surgical procedures. Double-lumen endotracheal tubes and one-lumen tracheal tube combined with bronchial blocker might lead to intubation-related laryngeal injury. PATIENT CONCERNS: In the perioperative period, how to avoid further damage to the vocal cord while achieving OLV during operation is challenging work. DIAGNOSIS: She was diagnosed with systemic lupus erythematosus, bilateral vocal cord paralysis, and lung tumor. INTERVENTIONS: We used a combination of a laryngeal mask airway with bronchial blocker to avoid further damage to the vocal cord when achieving OLV. OUTCOMES: At 1-month follow-up, she had fully recovered without obvious abnormalities. CONCLUSION: When OLV was required for patients with bilateral vocal cord paralysis, a combination of a laryngeal mask airway with bronchial blocker was considered a better choice.

Effect of remote ischemic preconditioning on postoperative cognitive dysfunction in adult patients with general anesthesia: a meta-analysis.

BACKGROUND: Remote ischemic preconditioning (RIPC) is proven to have neuroprotective protective effects. Nevertheless, the impact of RIPC on postoperative cognitive dysfunction (POCD) in patients undergoing general anesthesia is controversial. This meta-analysis of randomized controlled trials (RCTs) aimed to assess the effect of RIPC on POCD in adults after general anesthesia. METHODS: Relevant literature was obtained by searching Embase, PubMed, Web of Science, Cochrane Library, Wanfang, and China National Knowledge Infrastructure (CNKI) databases in July 2022. RCTs were included to assess the influences of RIPC on POCD in adults following general anesthesia. Two investigators independently performed literature screening, data extraction, and quality assessment based on the inclusion and exclusion criteria. The incidence of POCD, operation time, and hospital stay were analyzed by Review manager5.4 software. RESULTS: Thirteen RCTs with 1122 participants were selected for this meta-analysis. Compared to the control group, RIPC decreased the incidence of POCD (OR = 0.50, 95% CI 0.31-0.82), as well as reduced the duration of hospitalization (MD = - 0.98, 95% CI - 1.69 to - 0.27), but did not prolong operative time (MD = - 2.65, 95% CI - 7.68 to 2.37). CONCLUSION: RIPC reduced the incidence of POCD in adult patients after general anesthesia and accelerated their discharge.

Thoracic delirium index for predicting postoperative delirium in elderly patients following thoracic surgery: A retrospective case-control study.

BACKGROUND: Postoperative delirium (POD) is an acute neurological complication in the elderly undergoing thoracic surgery and can result in serious adverse consequences. AIMS: This study aimed to identify the related risk factors for POD following thoracic surgery, primarily focusing on preoperative serum biomarkers, and further to establish a novel delirium index to better predict POD. METHODS: A total of 279 patients aged ≥60 years who underwent elective thoracic surgery from August 2021 to August 2022 were enrolled in this observational study. The platelet-to-white blood cell ratio (PWR) was calculated as number the of platelets divided by the number of white blood cells. POD was defined by the confusion assessment method twice daily during the postoperative first 3 days. Multivariate regression analysis was performed to identify all potential variables for POD. Moreover, a novel thoracic delirium index (TDI) was developed based on the related risk factors. The accuracy of TDI and its component factors in predicting POD was determined by the curve of receiver operating characteristic (ROC). RESULTS: In total, 25 of 279 patients developed POD (8.96%). Age, PWR, and average pain scores within the first 3 days after surgery were regarded as the independent risk factors for POD. Moreover, the ROC analysis showed the TDI, including age, PWR, and average pain scores within the first 3 days after surgery, can more accurately predict POD with the largest area under the curve of 0.790 and the optimal cutoff value of 9.072, respectively. CONCLUSION: The TDI can scientifically and effectively predict POD to provide optimal clinical guidance for older patients after thoracic surgery.

Protective effect of Danshensu against neurotoxicity induced by monosodium glutamate in adult mice and their offspring.

Excessive neuronal excitation by glutamate is a well-established cause of neurotoxicity, leading to severe impairment of brain function. Excitotoxicity is a key factor in numerous neurodegenerative conditions. In this study, we investigated the neuroprotective effects of Danshensu (DSS) against monosodium glutamate (MSG)-induced neurotoxicity in adult mice and their offspring. We randomly divided one hundred 8-week-old Kunming mice (equal number of males and females) into a control group and an experimental group. The experimental group was further subdivided into various treatment groups, including MSG gavage treatment, bwbw DSS treatment group 1 (bwbw DSS treatment group 2, a drug control group, and a normal control group (receiving an equal volume of physiological saline for ten consecutive days). Additionally, another one hundred healthy 8-week-old Kunming mice were similarly divided into groups and treated. These mice were paired randomly (one male and one female) and pregnant females were housed separately to obtain offspring. Subsequently, we conducted histological and behavioral analyses on adult mice and their offspring. MSG treatment induced significant cellular edema and hippocampal damage in both the treated mice and their offspring. However, varying doses of DSS effectively counteracted the neurotoxic effects of MSG, with no adverse impact on brain tissue structure or neural function in either adult mice or their offspring. Behavioral experiments further confirmed that DSS exerted a substantial protective effect against MSG-induced impairment of learning and memory in the treated adult mice and their offspring, in addition to mitigating central nervous system overexcitation and inhibiting exploratory behavior. In conclusion, DSS exerts significant protective effects against MSG-induced neurotoxicity in both adult mice and their offspring.

The impact of goal-directed fluid therapy on postoperative pulmonary complications in patients undergoing thoracic surgery: a systematic review and meta-analysis.

BACKGROUND: Pulmonary complications after thoracic surgery are common and associated with significant morbidity and high cost of care. Goal-directed fluid therapy (GDFT) could reduce the incidence of postoperative pulmonary complications (PPCs) and facilitate recovery in patients undergoing major abdominal surgery. However, whether GDFT could reduce the incidence of PPCs in patients undergoing thoracic surgery was unclear. The present meta-analysis was designed to assess the impact of Goal-directed Fluid Therapy on PPCs in patients undergoing thoracic surgery. METHODS: Randomized controlled trials (RCTs) comparing GDFT with other conventional fluid management strategies in adult patients undergoing thoracic surgery were identified. Databases searched included PubMed, Web of Science, Embase, and Cochrane Library databases. Review Manager 5.4 (The Cochrane Collaboration, Oxford, UK) software was used for statistical analysis. Heterogeneity was analyzed using I2 statistics, and a standardized mean difference with 95% CI and P value was used to calculate the treatment effect for outcome variables. The primary study outcomes were the incidence of PPCs. Secondary outcomes were the total volume infused, the length of hospitalization, the incidence of cardiac complications, and the incidence of renal dysfunction. Subgroup analysis was planned to verify the definite role of GDFT. RESULTS: A total of 6 RCTs consisting of 680 patients were included in this meta-analysis, which revealed that GDFT did not reduce the incidence of PPCs in patients undergoing thoracic surgery (RR, 0.57; 95% CI 0.29-1.14). However, GDFT decreased the total intra-operative fluid input (MD, - 244.40 ml; 95% CI - 397.06 to - 91.74). There was no statistical difference in the duration of hospitalization (MD; - 1.31, 95% CI - 3.00 to 0.38), incidence of renal dysfunction (RR, 0.62; 95% CI 0.29-1.35), and incidence of cardiac complications (RR, 0.62; 95% CI 0.27-1.40). CONCLUSIONS: The results of this meta-analysis indicate that GDFT did not reduce the postoperative incidence of pulmonary complications in individuals undergoing thoracic surgery. However, considering the small number of contributing studies, these results should be interpreted with caution.

The effect of haloperidol's perioperative application on postoperative delirium in elderly patients: a systematic review and meta-analysis.

OBJECTIVES: To systematically review the evidence about the effect of haloperidol on postoperative delirium in elderly patients. METHODS: PubMed, Embase, the Cochrane Library and China National Knowledge Infrastructure were used to find concerned studies for meta-analysis. The main outcome was the incidence of postoperative delirium, and the secondary outcomes were side effects of haloperidol and the length of hospital stay. The meta-analyses were conducted using the Review Manager Version 5.1. This study was conducted based on the PRISMA statement. RESULTS: Eight RCTs (1569 patients) were included in the meta-analysis. There was a significant difference in the incidence of postoperative delirium between haloperidol and control groups (OR = 0.62, 95%CI 0.48-0.80, P = 0.0002, I2 = 20%). In addition, side effects of haloperidol and the duration of hospitalization were comparable (OR = 0.58, 95%CI 0.25-1.35, P = 0.21, I2 = 0%; MD =-0.01, 95%CI -0.16-0.15, P = 0.92, I2 = 28%). Subgroup analysis implied the effect of haloperidol on postoperative delirium might vary with the dose (5 mg daily: OR = 0.40, 95%CI 0.22-0.71, P = 0.002, I2 = 0%; <5 mg daily: OR = 0.72, 95%CI 0.42-1.23, P = 0.23, I2 = 0%). CONCLUSIONS: The meta-analysis revealed perioperative application of haloperidol could decrease the occurrence of postoperative delirium without obvious side effects in elderly people, and high-dose haloperidol (5 mg daily) possessed a greater positive effect.

Five new secondary metabolites from Aster tataricus.

Aster tataricus L.f. is highly valued for its rich reserves of bioactive compounds. Our research focused on the identification of previously unreported compounds found within the ethanol extract of A. tataricus. Through meticulous spectroscopic analyses and computational methods like NMR calculations and ECD, we successfully elucidated the structures of five novel compounds termed tatarisides A-E (1-5), alongside two known compounds (6, 7). The anti-inflammatory assays conducted yielded noteworthy results, particularly in relation to compounds 1 and 5. These compounds exhibited significant potential in inhibiting the release of NO in LPS-induced RAW 264.7 cells, as evidenced by their respective IC50 values of 17.81 ± 1.25 µM and 13.32 ± 0.84 µM. The discovery of these new compounds adds to the existing knowledge of A. tataricus's chemical composition and potential applications.

Effects of Acupuncture-Point Stimulation on Perioperative Sleep Disorders: A Systematic Review with Meta-Analysis and Trial Sequential Analysis.

Background: Perioperative sleep disorders exert a severe adverse impact on postoperative recovery. Recently, some observational studies reported that acupuncture-point stimulation (APS) provided benefits for promoting perioperative sleep quality. However, the effects of APS on perioperative sleep disorders following general anesthesia have not been thoroughly assessed by any systematic study and meta-analysis. Therefore, we conducted this systematic review and meta-analysis to reveal the effects of APS on perioperative sleep disorders. Methods: Eight databases (Chinese: CNKI, VIP, CBM, and Wanfang; English: PubMed, Embase, Web of Science, and Cochrane Library) were thoroughly searched to find randomized controlled trials (RCTs) that indicated a link between APS and the occurrence of perioperative sleep disorders. We applied RevMan 5.4 (Cochrane Collaboration) and Stata 16.0 (Stata Corp) to conduct our meta-analysis. In addition, the trial sequential analysis (TSA) tool was utilized to estimate the validity and reliability of the data. Results: In this study, nine RCTs with 719 patients were conducted. Compared to the control group, APS significantly improved perioperative subjective sleep quality (SMD: -1.36; 95% CI: -1.71 to -1.01; P < 0.00001). Besides, it increased perioperative TST (preoperative period MD = 24.29, 95% CI: 6.4 to 42.18, P = 0.0008; postoperative period MD = 45.86, 95% CI: 30.00 to 61.71, P < 0.00001) and SE (preoperative MD = 3.62, 95% CI: 2.84 to 4.39, P < 0.00001; postoperative MD = 6.43, 95% CI: 0.95 to 11.73, P < 0.00001). The consequence of trial sequential analysis further confirmed the reliability of our meta-analysis results. Conclusion: According to the currently available evidence, APS could effectively improve perioperative sleep quality and play an essential role in decreasing the incidence of perioperative sleep disorders.

Prospective prenatal cell-free DNA screening for genetic conditions of heterogenous etiologies.

Prenatal cell-free DNA (cfDNA) screening uses extracellular fetal DNA circulating in the peripheral blood of pregnant women to detect prevalent fetal chromosomal anomalies. However, numerous severe conditions with underlying single-gene defects are not included in current prenatal cfDNA screening. In this prospective, multicenter and observational study, pregnant women at elevated risk for fetal genetic conditions were enrolled for a cfDNA screening test based on coordinative allele-aware target enrichment sequencing. This test encompasses the following three of the most frequent pathogenic genetic variations: aneuploidies, microdeletions and monogenic variants. The cfDNA screening results were compared to invasive prenatal or postnatal diagnostic test results for 1,090 qualified participants. The comprehensive cfDNA screening detected a genetic alteration in 135 pregnancies with 98.5% sensitivity and 99.3% specificity relative to standard diagnostics. Of 876 fetuses with suspected structural anomalies on ultrasound examination, comprehensive cfDNA screening identified 55 (56.1%) aneuploidies, 6 (6.1%) microdeletions and 37 (37.8%) single-gene pathogenic variants. The inclusion of targeted monogenic conditions alongside chromosomal aberrations led to a 60.7% increase (from 61 to 98) in the detection rate. Overall, these data provide preliminary evidence that a comprehensive cfDNA screening test can accurately identify fetal pathogenic variants at both the chromosome and single-gene levels in high-risk pregnancies through a noninvasive approach, which has the potential to improve prenatal evaluation of fetal risks for severe genetic conditions arising from heterogenous molecular etiologies. ClinicalTrials.gov registration: ChiCTR2100045739 .

Peripheral nerve block and cognitive impairment after thoracic surgery: a systematic review and meta-analysis.

INTRODUCTION: Postoperative cognitive impairment is common in surgical patients, including postoperative delirium and postoperative cognitive dysfunction. Several studies investigating the association between peripheral nerve block and the risk of cognitive impairment after thoracic surgery showed conflicting results. Therefore, we conducted the current systematic review and meta-analysis to determine the effects of peripheral nerve block on postoperative cognitive impairment in thoracic surgical patients. EVIDENCE ACQUISITION: Eligible randomized controlled trials were retrieved from PubMed, Cochrane Library, Web of Science and Embase databases. The primary outcomes were the incidence of postoperative delirium or cognitive dysfunction and the MMSE scores. Furthermore, VAS scores, levels of TNF-α and IL-6, as well as the duration of hospitalization were analyzed as secondary outcomes. EVIDENCE SYNTHESIS: Ten articles including 1279 participants were selected for this meta-analysis. The results presented that peripheral nerve block could lessen the incidence of postoperative delirium or cognitive dysfunction (OR=0.39, 95% CI [0.27 to 0.56]), the scores of VAS (MD=-1.35 [95% CI: -2.30 to -0.40]), the values of TNF-α (SMD=-1.13 [95% CI: -1.49 to -0.76]) and IL-6 (SMD=-1.65 [95% CI: -1.87 to -1.42]), as well as the length of hospitalization (MD=-0.70 [95% CI: -0.96 to -0.43]). In addition, peripheral nerve block was linked to a significant increase in MMSE scores (MD=2.16 [95% CI: 1.40 to 2.91]). CONCLUSIONS: This meta-analysis revealed positive effects of peripheral nerve block on improving postoperative cognitive impairment in patients following thoracic surgery.

Neuronal intranuclear inclusion disease with cortical involvement in left hemisphere: a case report.

BACKGROUND: Neuronal intranuclear inclusion disease (NIID) is a rare highly heterogeneous disease. In this paper, we present a case of NIID featured in cortical involvement in left hemisphere of brain and the imaging changes in the process of the disease. CASE PRESENTATION: A 57-year-old female was hospitalized due to recurrent attacks of headache with cognitive impairment and tremor for 2 years. The symptoms of headache episodes were reversible. The characteristic radiologic change was high intensity signal involving the grey matter-white matter junction on the brain diffusion-weighted imaging (DWI), which existed in the frontal lobe and then extended backwards. Atypical features on fluid-attenuated inversion recovery (FLAIR) sequences showing small patchy high signals in the cerebellar vermis. High signals and edema were detected on FLAIR images along the cortex of the left occipito-parieto-temporal lobes, expanding and gradually shrinking in the follow-up visit. Besides, cerebral atrophy and bilateral symmetrical leukoencephalopathy were also detected. Skin biopsy and genetic testing confirmed the diagnosis of NIID. CONCLUSION: Except for typical radiological change strongly suggesting NIID, it is also necessary to notice the insidious symptoms of NIID combining with some atypical imaging features to make an early diagnosis. Skin biopsies or genetic testing should be carried out early in patients with highly suspected NIID.

Old trees bloom new flowers, lysosome targeted near-infrared fluorescent probe for ratiometric sensing of hypobromous acid in vitro and in vivo based on Nile red skeleton.

Hypobromous acid (HOBr), one of the significant reactive oxygen species (ROS) that acts as an important role in human immune system, however the increasing level of HOBr in human body can cause the disorder of eosinophils (EPO), leading to oxidative stress in organelles, and further causing a series of diseases. In this study, a ratiometric fluorescent probe DMBP based on Nile red skeleton was developed to detect HOBr specifically by the electrophilic substitution with HOBr. DMBP emits near-infrared (NIR) fluorescence at 653 nm, after reacting with HOBr, the emission wavelength of DMBP shifted blue and a new peak appeared at 520 nm, realizing a ratiometric examination of HOBr with a limit of detection of 89.00 nM. Based on its sensitive and specific response to HOBr, DMBP was applied in the visual imaging of HOBr in HepG2 cells and zebrafish. Foremost, probe DMBP has excellent lysosome targeting ability and NIR emission reduced the background interference of biological tissues, providing a potential analytical tool to further investigate the role of HOBr in lysosome.

Loss of Gucy1a3 causes poor post-stroke recovery by reducing angiogenesis via the HIF-1α/VEGFA signaling pathway in mice.

OBJECTIVES: Ischemic stroke is a common and debilitating disease that can cause permanent neurological damage. Gucy1a3, which encodes the α1 subunit of soluble guanylyl cyclase, has been reported to be associated with functional recovery after ischemic stroke. However, the mechanism is still not well understood. In the present study, we investigated the effects of Gucy1a3 on (i) post-stroke recovery; (ii) vascular endothelial growth factor A (VEGFA) and hypoxia inducible factor 1 alpha (HIF-1α) expression; and (iii) angiogenesis after ischemic stroke. MATERIALS AND METHODS: Wild-type and Gucy1a3 knockout C57BL/6J male mice were respectively used to establish the models of permanent middle cerebral artery occlusion (pMCAO). Neurological deficit scores were evaluated at 24 h and 96 h after pMCAO. Cerebral infarct volume was measured by 2,3,5-triphenyltetrazolium chloride (TTC) staining. For determining microvessel density, immunohistochemical analysis was performed with CD31. The expression of VEGFA and HIF-1α was detected by western blotting. RESULTS: Our results suggest that loss of Gucy1a3 increased the infarct volume and aggravated neurological deficits after pMCAO. In addition, the Gucy1a3 knockout brains exhibited significantly lower microvessel densities and VEGFA and HIF-1α expression levels than the wild-type brains at 96 h post-pMCAO. CONCLUSIONS: Our study indicates that GUCY1A3 might be involved in angiogenesis after ischemic stroke. Further investigation of GUCY1A3 will provide a new therapeutic target for stroke.

Evaluating the impact of ultrasound-guided subsheath versus extrasheath sciatic nerve block on postoperative wound pain in tibial and foot surgeries: A systematic review and meta-analysis.

This systematic review and meta-analysis evaluate the impact of ultrasound-guided subsheath versus extrasheath sciatic nerve blocks on postoperative wound pain in tibial and foot surgeries, crucial for effective pain management and patient recovery. Adhering to PRISMA guidelines, this study used a PICO framework, focusing on patients undergoing tibial and foot surgeries and comparing the efficacy and safety of subsheath and extrasheath sciatic nerve blocks. The literature search spanned four databases without time restrictions, assessing various outcomes like success rate, onset time, duration of analgesia and complication rates. Quality assessment employed the Cochrane Collaboration's risk of bias tool, and statistical analyses included heterogeneity assessment, fixed-effect and random-effects models, sensitivity analysis and publication bias evaluation using funnel plots and Egger's linear regression test. From an initial pool of 1213 articles, six met the inclusion criteria. The subsheath group showed a significantly higher success rate of complete sensory blockade within 30 min compared with the extrasheath group (OR = 5.39; 95% CI: 2.82-10.28; p < 0.01). No significant differences were found in procedure duration or incidence of nerve-related complications between the two techniques. The subsheath approach also demonstrated a quicker onset time of sensory blockade (MD = -8.57; 95% CI: -11.27 to -5.88; p < 0.01). Sensitivity analysis confirmed the stability of the results, and no significant publication bias was detected. Ultrasound-guided subsheath sciatic nerve blocks are more effective than extrasheath blocks in achieving rapid and complete sensory blockade for tibial and foot surgeries, with a quicker onset time and comparable safety profile. Subsheath injections are thus recommended as a preferred method for anaesthesia and postoperative pain management in these surgical procedures, enhancing overall patient outcomes.

Transcutaneous electrical acupoint stimulation improves pulmonary function by regulating oxidative stress during one-lung ventilation in patients with lung cancer undergoing thoracoscopic surgery: a randomized controlled trial.

BACKGROUND: Our aim was to evaluate the efficacy of transcutaneous electrical acupoint stimulation (TEAS) on oxidative stress induced by one-lung ventilation, lung function, and postoperative quality of recovery in patients with lung cancer. METHODS: The participants (n = 80) were assigned to the sham group and TEAS group. TEAS on bilateral Feishu (BL13), Zusanli (ST36), and Hegu (L14) was performed 30 minutes before induction of anesthesia and continued until the end of the surgery. In the sham group, the same acupoints were selected without electrical stimulation. PaO2/FiO2, intrapulmonary shunt ratio (Qs/Qt), alveolar-arterial oxygen tension (A-aDO2), and respiratory index (RI) were calculated to evaluate lung function before one-lung ventilation (T0), 30 min after one-lung ventilation (T1), 1 h after one-lung ventilation (T2), and 10 min after resuming two-lung ventilation (T3). The levels of malondialdehyde (MDA) and superoxide dismutase (SOD) were detected to estimate oxidative stress at T0, T1, T2, and T3. Secondary outcomes included removal time of thoracic drainage tube, duration of intensive care unit (ICU) stay, length of postoperative hospitalization, the incidence of postoperative pulmonary complications, and the Quality of Recovery-15 (QoR-15) score on postoperative day 1 and 2. RESULTS: TEAS significantly increased PaO2/FiO2 at T1 and T2, while Qs/Qt, A-aDO2, and RI decreased remarkably from T1 to T3 (P < 0.05). Meanwhile, TEAS obviously decreased MDA and increased SOD activity at T2 and T3 (P < 0.05). Furthermore, TEAS also markedly shortened the length of ICU stay and hospital stay after surgery, whereas the QoR-15 score on postoperative day 1 and 2 was significantly higher (P < 0.05). CONCLUSIONS: TEAS could reduce oxidative lung injury during one-lung ventilation, thereby protecting pulmonary function and effectively accelerating the early recovery of patients with lung cancer. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2000038243).

The risk factors of postoperative cognitive dysfunction in patients undergoing carotid endarterectomy: an updated meta-analysis.

OBJECTIVE: The purpose of the current meta-analysis was to determine the incidence and risk factors to provide a scientific basis for prevention and treatment of postoperative cognitive dysfunction (POCD) after carotid endarterectomy (CEA). METHODS: Relevant articles published before October 2022 were searched from Pubmed/MEDLINE, Cochrane and Embase databases. The outcomes were the incidence and risk factors for POCD. A random-effects model was applied to estimate the overall odds ratios (ORs) and mean differences (MDs) for all risk factors through STATA 14.0 and RevMan 5.4. The quality of eligible studies was evaluated by Newcastle-Ottawa Scale (NOS) as previously described. RESULTS: A total of 22 articles involving 3459 CEA patients were finally identified. The weighted mean incidence of POCD was 19% (95% confidence intervals (95% CI) 0.16-0.24, P < 0.001). Of the 16 identified risk factors, hyperperfusion (OR: 0.54, 95% CI 0.41-0.71) and degree of internal carotid artery (ICA) stenosis (OR: 5.06, 95% CI 0.86-9.27) were the potential risk factors of POCD, whereas patients taking statins preoperative had a lower risk of POCD (OR: 0.54, 95% CI 0.41-0.71). Subgroup analysis revealed that the risk of POCD at 1 month after CEA was higher in patients with diabetes (OR: 1.70, 95% CI 1.07-2.71). CONCLUSION: The risk factors of POCD were hyperperfusion and degree of ICA stenosis, while diabetes could significantly increase the incidence of POCD at 1 month after surgery. Additionally, preoperative statin use could be a protective factor for POCD following CEA.

Risk factors for failure of conversion from epidural labor analgesia to cesarean section anesthesia and general anesthesia incidence: an updated meta-analysis.

OBJECTIVES: Ongoing controversies persist regarding risk factors associated with the failure of transition from epidural labor analgesia to cesarean section anesthesia, including the duration of labor analgesia, gestational age, and body mass index (BMI). This study aims to provide an updated analysis of the incidence of conversion from epidural analgesia to general anesthesia, while evaluating and analyzing potential risk factors contributing to the failure of this transition to cesarean section anesthesia. METHODS: We conducted an extensive literature search utilizing databases such as PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WANGFANG, and the Chinese Biomedical Literature Database (CBM) up to September 30, 2022. The meta-analysis was performed using STATA 15.1 software. The quality of the included studies was assessed using the 11-item quality assessment scale recommended by the Agency for Healthcare Research and Quality (AHRQ). RESULTS: A total of 9,926 studies were initially retrieved, and after rigorous selection, 19 studies were included in the meta-analysis. The overall incidence of conversion from epidural analgesia to general anesthesia was found to be 6% (95% confidence interval [CI]: 5-8%). Our findings indicate that, when compared to patients in the successful conversion group, those in the failure group tended to be younger (weighted mean difference [WMD] = -1.571, 95% CI: -1.116 to -0.975) and taller (WMD = 0.893, 95% CI: 0.018-1.767). Additionally, the failure group exhibited a higher incidence of incomplete block in epidural anesthesia, received a higher dosage of additional epidural administration, experienced a greater rate of emergency cesarean sections, and received anesthesia more frequently from non-obstetric anesthesiologists. However, no statistically significant differences were observed in gestational age, depth of the catheter insertion into the skin, epidural catheter specifics, duration of epidural analgesia, infusion rate of epidural analgesia, primiparity status, cervical dilatation during epidural placement, BMI, or weight. CONCLUSION: Our study found that the incidence of conversion from epidural analgesia to cesarean section under general anesthesia was 6%. Notably, the failure group exhibited a higher rate of incomplete block in epidural anesthesia, a greater incidence of emergency cesarean sections, a more frequent provision of anesthesia by non-obstetric anesthesiologists, a higher dosage of epidural administration, and greater height when compared to the success group. Conversely, women in the failure group were younger in age compared to their counterparts in the success group.

The impact of preoperative malnutrition on postoperative delirium: a systematic review and meta-analysis.

BACKGROUND: Postoperative delirium (POD) is a common postoperative complication, characterized by disturbance of attention, perception, and consciousness within 1 week after surgery, and linked to cognitive decline, increased mortality, and other serious surgical outcomes. Early identification and treatment of risk factors for POD could reduce the occurrence of delirium and the related poor outcomes. Malnutrition as a possible precipitating factor, defined as the poor anthropometric, functional, and clinical outcomes of nutrient deficiency, has been investigated. However, the evidence is controversial. The goal of this systematic review and meta-analysis was to comprehensively assess the correlation between preoperative malnutrition and POD. METHODS: PubMed, Embase, Cochrane Library, and Web of Science were used to search prospective cohort articles that explored the correlation between preoperative malnutrition and POD from inception until September 30, 2022. Two researchers independently conducted the literature selection and data extraction. The quality of the literature was evaluated according to the Newcastle-Ottawa scale (NOS). Odds ratios (ORs) and 95% confidence intervals (CIs) for POD associated with malnutrition relative to normal nutritional status were calculated. RESULTS: Seven prospective cohort studies qualified for the meta-analysis, which included 2701 patients. The pooled prevalence of preoperative malnutrition was 15.1% (408/2701), and POD occurred in 428 patients (15.8%). The NOS score was above 7 points in all 7 studies. Our results demonstrated that the pooled OR for malnutrition and POD was 2.32 (95% CI 1.62-3.32) based on a random-effects model. Our subgroup analysis suggested that the relationship between malnutrition and POD was significant in adults following noncardiac surgery (OR = 3.04, 95% CI, 1.99-4.62, P < 0.001), while there was no statistical significance in adults following cardiac surgery (OR = 1.76, 95% CI, 0.96-3.22, P = 0.07). Additionally, in the subgroup analysis based on different malnutrition assessment tools (MNA-SF versus others), a significant association was found in the MNA-SF group (OR = 3.04, 95% CI, 1.99-4.62, P < 0.001), but not in the others group (OR = 1.76, 95% CI, 0.96-3.22, P = 0.07). Other subgroup analyses showed that this association was not significantly affected by evaluation instruments for POD, location of the study, or quality of the article (all P < 0.05). CONCLUSIONS: Based on the currently available evidence, our results suggested that preoperative malnutrition was independently associated with POD in adult surgical patients.