Su Min

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% CI (0.16, 1.27)] and irrigation fluid warming [RR = 0.95, 95% CI (0.27, 3.30)] demonstrated a numerically lower incidence of IH compared with forced-air warming (FAW). For FAW blanket type, the incidence of IH in FAW-Lower-body [RR = 1.54, 95% CI (1.17, 2.04)] and FAW-Surgical-access blanket [RR = 1.44, 95% CI (1.01, 2.06)] was significantly higher than that in FAW-Underbody. Compared with FAW alone, multiple combined warming strategies without prewarming exhibited numerically reduced IH incidence, such as irrigation fluid warming + intravenous fluid warming + FAW [RR = 0.44, 95% CI (0.04, 4.40)]. Compared with FAW alone, prewarming + FAW showed significantly lower IH incidence [RR = 0.66, 95% CI (0.45, 0.96)]. FAW remains the pragmatic standard for preventing IH, with the underbody type preferred whenever clinically feasible. We conditionally recommend combining FAW with prewarming and fluid warming in high-risk contexts (particularly for older patients and prolonged surgery), although wide prediction intervals suggest these added benefits should be interpreted cautiously. PROSPERO Registration Number: CRD420251148645.

Background: Physical 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. Methods: We 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). Results: Fifteen 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. Conclusion: Green 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 registration: PROSPERO, CRD420261279222.

Background: Inflatable 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. Methods: This 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 cmH ₂ O. 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. Results: 78 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. Conclusion: In 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 registration: ClinicalTrials.gov , identifier NCT06954857.

The online version contains supplementary material available at 10.1038/s41598-026-41395-5.

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.

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 D ₂ -type medium spiny neurons (D ₂ -MSNs) in the NAcS bidirectionally modulated pain and its comorbid behavioral despair measured in the forced swimming test (FST), an effect possibly involving adenosine A _2A receptors (A _2A Rs). Specifically, acute chemogenetic activation of NAcS D ₂ -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 D ₂ -MSNs alleviated spared nerve injury (SNI) induced neuropathic pain and its comorbid behavioral despair. Our immunofluorescent staining revealed a relatively enriched expression of A _2A Rs in NAcS D ₂ -MSNs. Ex vivo electrophysiological recordings revealed that activating and inhibiting A _2A Rs increased and decreased the neuronal excitability of NAcS D ₂ -MSNs. Consistently, local infusion of the agonist and antagonist of A _2A Rs 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 D ₂ -MSNs in mediating PDC, which was possibly modulated by local A _2A Rs, thus providing a potential therapeutic target for PDC.

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.

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.