Min Li

Painful diabetic neuropathy (PDN) is characterized by hyperalgesia and neuronal hyperexcitability. Although gut microbiota dysbiosis has been found in PDN, the mechanisms by which the microbiota influence PDN remain largely unknown. Gut microbiota and its metabolites impacted PDN were investigated with multi-omics analyses in a rat model of high-fat diet/low-dose streptozotocin-induced type 2 diabetes. A significant decrease in the gut microbiota, including Clostridium, Lactobacillus, and Bifidobacterium, as well asin serum level of hyodeoxycholic acid (HDCA), was found in the PDN rats. Transplantation of fecal microbiota from the PDN to normal rats recapitulated the PDN phenotype, and HDCA treatment was able to alleviate the hyperalgesia of PDN. RNA sequencing and molecular assays showed that HDCA suppressed neuroinflammation by inhibiting the TLR4/MyD88/NF-κB pathway and reducing proinflammatory cytokine production in the DRG. These findings identify HDCA as a microbiota-derived metabolite that ameliorates PDN via neuroinflammation inhibition and highlight its therapeutic potential.

Postoperative pulmonary complications (PPCs) remain a primary driver of perioperative morbidity and extended hospital stays following paediatric scoliosis correction surgery, contributing significa...

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%, stroke volume (SV) by 36.2%, cardiac output (CO) by 38.7% (all P < 0.001). Hypotension (SBP drop > 20%) occurred in 76.7%. Crucially, SV reduction preceded blood pressure fall: at the first post‑spinal measurement, SV had already decreased by 30.6%, while systolic BP had fallen by only 12.2%. Left ventricular ejection fraction (LVEF) remained stable throughout. After fetal delivery, all parameters partially recovered. Serial TTE monitoring detects a significant reduction in SV consistently before hypotension becomes clinically apparent, demonstrating the potential of TTE‑derived parameters as physiological indicators of preload changes. These findings establish a monitoring‑based physiological baseline for future hypothesis‑testing in obstetric anesthesia. Trial registration: Chinese Clinical Trial Registry (ChiCTR2500111576; registered 3 November 2025).

Background: Acute moderate-to-severe postoperative pain is common after Achilles tendon surgery and may hinder early mobilization and the implementation of Enhanced Recovery After Surgery (ERAS) protocols. This study aimed to develop and internally validate a perioperative nomogram for predicting acute moderate-to-severe pain within the first 24 hours after Achilles tendon surgery using routinely available clinical variables. Methods: We retrospectively analyzed 489 patients who underwent Achilles tendon surgery at a single center. Demographic, surgical, and perioperative analgesic data were extracted from electronic medical records. The primary outcome was moderate-to-severe postoperative pain, defined as any Numeric Rating Scale (NRS) score ≥ 4 within the first 24 postoperative hours. Candidate predictors were screened using Least Absolute Shrinkage and Selection Operator (LASSO) regression, followed by multivariable logistic regression to construct a parsimonious predictive model. The model was intended for perioperative use at or near the end of surgery, when the surgical approach and peripheral nerve block status are known. Model performance was evaluated using the Area Under the Curve (AUC), calibration plots, bootstrap internal validation, temporal split validation, and Decision Curve Analysis (DCA). Results: Among the 489 patients, 208 (42.5%) experienced moderate-to-severe postoperative pain. The final model included open surgery (OR 4.457, 95% CI 2.109– 9.417), higher BMI (OR 1.059 per 1 kg/m², 95% CI 1.006– 1.115), and no peripheral nerve block (OR 2.022, 95% CI 1.369– 2.988). The apparent C-statistic was 0.652 (95% CI 0.603– 0.700), and the bootstrap-corrected C-statistic was 0.648. Calibration was acceptable (optimism-corrected calibration slope 0.950; optimism-corrected calibration intercept − 0.017; Hosmer-Lemeshow P = 0.162). In temporal split validation, the model achieved an AUC of 0.634 (95% CI 0.565– 0.703). Decision curve analysis suggested potential net benefit across threshold probabilities from 0.11 to 0.56. Conclusion: Open surgery and higher BMI were associated with increased odds of acute moderate-to-severe postoperative pain, whereas perioperative peripheral nerve block was associated with lower odds. The proposed 3-variable nomogram showed modest discrimination and acceptable internal calibration. It may serve as an adjunctive tool for perioperative risk stratification, but external validation and prospective evaluation are required before routine clinical use.

1. Spinal surgery frequently induces severe postoperative pain due to extensive tissue injury involving vertebral structures, intervertebral discs, and neural elements, resulting in both nociceptiv...

Painful diabetic neuropathy (PDN) is frequently accompanied by anxiety, yet the neural circuit mechanisms associated with nociceptive hypersensitivity to affective dysfunction remain unclear. Here we combined brain-wide c-Fos mapping, viral tracing, in vivo fiber photometry, whole-cell recordings, and projection-specific opto/chemogenetics in a mouse model of streptozotocin-induced PDN to define a thalamo-cortex circuit for pain-anxiety comorbidity. Within the posterior insular cortex (pIC), CaMKIIα⁺ excitatory neurons were recruited in PDN mice with comorbid anxiety, exhibiting heightened neuronal excitability and enhanced excitatory synaptic input. Bidirectional chemogenetic modulation of pIC^CaMKIIα neurons oppositely regulated anxiety-like behavior and mechanical hypersensitivity without locomotor or glycemic confounds. Circuit mapping identified a monosynaptic excitatory projection from the paraventricular thalamus (PVT) to the pIC; PVT^CaMKIIα neurons were hyperactive in PDN, and projection-defined manipulation of the PVT^CaMKIIα to pIC^CaMKIIα pathway bidirectionally controlled the behavioral phenotypes. Cacna1c was upregulated in the PVT of PDN mice; its knockdown in pIC-projecting PVT^CaMKIIα neurons attenuated both pain and anxiety-like behaviors. Together, these results delineate a thalamo-cortex excitatory pathway that couples nociceptive and affective dimensions of PDN and suggest that selective targeting of the PVT^CaMKIIα to pIC^CaMKIIα circuit may provide coordinated relief of pain and anxiety-related symptoms.

Rationale: Electroacupuncture (EA) has been widely used for depression treatment. Microbiota-gut-brain (MGB) axis plays a vital role in regulating emotional behaviors. However, the potential role of MGB axis in EA-mediated protective effects remains unclear. Methods: The protective effects of EA in chronic unpredictable mild stress (CUMS) induced mice were evaluated, and the gut microbiota and metabolic profiles were analyzed. Fecal microbiota transplantation (FMT) was utilized to explore the role of MGB axis in the protective effects of EA. Analyses related to synaptic pruning mediated by microglia were conducted to explore the molecular mechanisms. Results: In this study, EA treatment prevented depressive-like behaviors in CUMS mice. Mechanistically, EA ameliorated CUMS-induced gut microbiota dysbiosis and inflammation, and partially restored gut microbial metabolism, particularly affecting the abundance of Alistipes and taurine metabolism. Furthermore, EA significantly reduced systemic and hippocampal inflammation. It also attenuated aberrant synaptic pruning in the hippocampus. Moreover, FMT from CUMS mice induced depressive-like behaviors, gut inflammation and microglia-mediated aberrant synaptic pruning, whereas FMT from EA-treated donors exerted protective effects against these impairments. Conclusion: Collectively, our findings suggest that EA prevented CUMS-induced depression-like behaviors and support the involvement of the MGB axis in its protective effects.

Objective To evaluate the relationship between preoperative COVID-19 infection and major postoperative pulmonary complications (PPC) risk after major elective surgeries during the Omicron wave. Design A multicentre, prospective, observational cohort study. Setting Four tertiary medical centres in Beijing, China. Participants All adult patients who underwent major elective surgeries under general anaesthesia from 30 December 2022 to 18 May 2023 were screened for eligibility. A total of 3211 patients were included. Primary and secondary measures The primary outcome was 30-day major PPC, defined as pneumonia, acute respiratory distress syndrome or unexpected postoperative ventilation. The secondary outcomes included length of hospital stay (LOS), reoperation and mortality. Results Major PPC occurred in 3.5% of patients with preoperative COVID-19 and 3.3% of those without. Inverse probability of treatment weighting-adjusted analysis showed no significant association between preoperative COVID-19 within 12 weeks and PPC risk (adjusted OR, 0.89; 95% CI 0.69 to 1.13). However, multivariable analysis revealed that COVID-19 infection within 3 weeks was independently associated with an increased PPC risk (OR, 3.44; 95% CI 1.37 to 8.68). Cardiothoracic surgery (OR, 12.47; 95% CI 8.11 to 19.17) and longer duration of surgery (OR, 1.24 per hour; 95% CI 1.13 to 1.37) were significant risk factors. In the cardiothoracic subgroup, PPC risk was significantly elevated within 7 weeks of infection. No significant differences were observed in LOS, reoperation rates or mortality between patients with and without preoperative COVID-19 infection. Conclusions Preoperative COVID-19 infection within 12 weeks was not associated with an increased overall risk of major PPC during the Omicron wave. Although very short infection-to-surgery intervals and cardiothoracic surgery showed exploratory signals of higher risk, these findings should be interpreted cautiously and support an individualised approach to perioperative risk assessment. Trial registration number ChiCTR2200067250.

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%) demonstrated significantly higher BMI (40.6 [38.1, 47.2] vs. 38.7 [34.9, 44.0] kg/m², p = 0.007), ASA III prevalence (66.7%% vs. 25.8%, p < 0.001), existence of OSAS (71.1% vs. 33.1%, p < 0.001), intraoperative peak end-tidal carbon dioxide partial pressure (41 [39, 46] vs.39 [36, 42] p < 0.001) and post-extubation hypoxemia incidence (62.2% vs. 9.7%, p < 0.001). Logistic regression analysis identified three independent predictors: post-extubation hypoxemia (OR = 14.771, 95%CI: 5.557 ~ 39.268), ASA III (OR = 3.924, 95%CI: 1.362 ~ 11.304), and OSAS (OR = 3.122, 95%CI:1.091 ~ 8.934). ASA III classification, preexisting OSAS, and post-extubation hypoxemia independently predict extended PACU-LOS in patients undergone laparoscopic sleeve gastrectomy. These findings underscore the imperative for preoperative risk stratification using standardized scoring systems, protocolized post-extubation oxygenation strategies, and resource allocation for high-dependency monitoring in at-risk patients. While this study establishes predictors of extended PACU-LOS, its correlation with postoperative complications warrants dedicated future investigation.