Zhongyu Wang

Neoadjuvant chemotherapy has become one of the initial treatment modalities for advanced ovarian cancer. Previous studies have indicated that preoperative neoadjuvant chemotherapy may reduce patients’ requirements for anesthetic agents. This study aims to investigate the effect of neoadjuvant chemotherapy on post-induction hypotension. This study enrolled a total of 532 patients, with 482 included in the primary analysis. Multivariable logistic regression and propensity score matching were used to analyze the association between Neoadjuvant chemotherapy and post-induction hypotension. Multiple sensitivity analyses were performed, including the use of alternative MAP thresholds, multiple imputation, inverse probability weighting, and E-value methods. This study enrolled a total of 532 patients, of whom 482 were included in the primary analysis. After propensity score matching, each group included 161 patients. The incidence of PIH were 29.19% in the non-NC group and 52.80% in the NC group (p < 0.001). Neoadjuvant chemotherapy was identified as an independent risk factor for post-induction hypotension in patients with ovarian cancer [adjusted OR 2.89 (1.90–4.42)], p < 0.001. Sensitivity analyses further supported the main conclusion. Patients receiving neoadjuvant chemotherapy were 2.89 times more likely to experience post-induction hypotension compared with those who did not, within the first 20 min after anesthesia induction. The online version contains supplementary material available at 10.1186/s12871-026-03800-4.

Although the understanding of pain mechanism and management has made substantial progress, postoperative pain relief is still an important health care problem. Surgical patients also often report preoperative and postoperative sleep problems. Clinical and experimental studies show that chronic pain and sleep disorders influence each other. Pain disturbs sleep, and sleep deprivation or sleep disorders increase pain. However, there are still many problems about the direction of causality between them and the mechanism that may explain their relationship. In-depth subjective and objective evaluation of pain and sleep supports the view that sleep disorder is a more powerful and reliable predictor of pain, and pain is a predictor of sleep disorder. Recent progress in multimodal imaging, molecular biology, and neural circuit analysis has uncovered how sleep deprivation — especially in the perioperative setting — influences pain sensitivity, the transition to chronic pain, and brain function through mechanisms spanning peripheral nerves, the spinal cord, subcortical areas, and cortical structures.

Objective: To develop and validate deep learning (DL) and machine learning (ML) models based on preoperative facial images and structured clinical data for predicting hypoxemia during adult painless gastrointestinal endoscopy, addressing the limitations of subjective and data‐intensive prediction methods. Methods: A total of 424 patients aged 18–80 years from the East Campus of the First Affiliated Hospital of Zhengzhou University (training/validation set) and 60 patients from the West Campus (test set) between October 2022 and October 2023 were included. A ResNet‐50 DL architecture and five ML algorithms (LightGBM, XGBoost, Random Forest, Logistic Regression, were Naive Bayes) were trained. K‐fold cross‐validation, data augmentation, and class weighting were applied to address class imbalance. Model performance was assessed using AUC, precision–recall curves, calibration curves, confusion matrices, class activation maps, and accuracy. Results: ResNet‐50 achieved the highest AUC of 0.8967 (95% CI: 0.8598–0.9402) and accuracy of 0.8500 (95% CI: 0.7333–0.9167), outperforming all ML models. LightGBM was the best ML performer (AUC: 0.8304; accuracy: 0.8176). Conclusions: The proposed ResNet‐50 model enables accurate, objective, and noninvasive prediction of hypoxemia risk using only facial images, offering a rapid preoperative risk assessment tool. This approach may enhance patient safety and streamline anesthesia workflows in outpatient endoscopy. Trial Registration: Chinese Registry of Clinical Trials: ChiCTR2400082682

Purpose: The effect of esketamine on perioperative inflammatory factors and postoperative analgesic outcomes in patients with Obstructive sleep apnea syndrome (OSAS) remains unclear. This trial assesses whether 0.25 mg · kg⁻ esketamine during general anesthesia can reduce the inflammatory level and relieve postoperative pain in OSAS patients. Patients and Methods: 96 adult patients with OSAS underwent palatopharyngoplasty under general anesthesia was included in our research. Following anesthetic introduction, subjects were randomized to either 0.25 mg · kg⁻ esketamine (in 20mL solution; esketamine group) or an equivalent volume of saline (Control group). The primary result was the level of IL-6 and TNF-α before the infusion of esketamine, 40min, 4h, and 24h after the esketamine infusion. Secondary outcomes was NRS scores immediately after tracheal extubation, 4h after the infusion, postoperative day 1 (POD1), postoperative day 2 (POD 2) and postoperative day 7 (POD 7). Results: The esketamine group demonstrated significantly reduced IL-6 and TNF-α levels at 40 minutes post-infusion (P< 0.001) and showed lower the numerical rating scale(NRS)scores with less rescue analgesia immediately after extubation (P< 0.001) compared to the control group, despite prolonged extubation and post-anesthesia care unit (PACU) stay (P< 0.001). Across POD1-2, the esketamine group maintained reduced NRS scores (P< 0.001) and analgesic doses (P=0.021), higher quality of recovery-15 (QoR-15) scores and patient satisfaction scores (P< 0.001) relative to control group. It is important to note that the significant differences in inflammatory markers and pain scores between groups were not sustained at the 24-hour assessment and on postoperative day 7, respectively, indicating transient effects. Conclusion: Intraoperative infusion of 0.25 mg·kg⁻ esketamine provided transient suppression of inflammatory responses and reduced early postoperative pain in OSAS patients. However, these benefits were exploratory and time-limited, and must be weighed against prolonged extubation and PACU stay.

Purpose: Postoperative delirium (POD) is a prevalent and severe complication in elderly patients undergoing major surgery, associated with increased morbidity and mortality. This randomized controlled trial aimed to investigate the effects of low-dose esketamine on the incidence of POD in elderly patients underwent total hip or knee arthroplasty. Patients and Methods: Two hundred and sixty elderly participants were randomly assigned to either the esketamine group (Group E) (0.20mg/kg loading, 0.125mg/kg/h infusion, 0.5 mg/kg for postoperative analgesia) or the placebo group (Group P) (received normal saline). The primary outcome was the incidence of POD, with secondary outcomes including delirium subtypes, duration, intraoperative analgesic consumption, operative and anesthesia times, hemodynamic changes, postoperative pain scores, sleep quality, and common postoperative adverse events. Results: There was no significant difference in the incidence of POD between Group E (8.5%) and Group P (10.8%). No significant differences were observed for the time of delirium onset, duration of delirium, and delirium subtype between the two groups. Patients in the esketamine group had more stable hemodynamic profile after induction and reduced the pain score of motion on the first two days postoperatively but increased the incidence of postoperative dizziness. Conclusion: The repeated infusion of low-dose esketamine did not reduce the incidence of POD during the initial three postoperative days in elderly patients following total hip or knee arthroplasty.

The primary aim of this research was to explore the functions of Wtap and Ythdf1 in regulating neuronal Lipocalin-2 (Lcn2) through m6A modification in traumatic brain injury (TBI). By employing transcriptome sequencing and enrichment analysis, we identified the Wtap/Ythdf1-mediated Lcn2 m6A modification pathway as crucial in TBI. In our in vitro experiments using primary cortical neurons, knockout of Wtap and Ythdf1 led to the inhibition of Lcn2 m6A modification, resulting in reduced neuronal death and inflammation. Furthermore, overexpression of Lcn2 in cortical neurons induced the activation of reactive astrocytes and M1-like microglial cells, causing neuronal apoptosis. In vivo experiments confirmed the activation of reactive astrocytes and microglial cells in TBI and importantly demonstrated that Wtap knockdown improved neuroinflammation and functional impairment. These findings underscore the significance of Wtap/Ythdf1-mediated Lcn2 regulation in TBI secondary injury and suggest potential therapeutic implications for combating TBI-induced neuroinflammation and neuronal damage.

Objective: While the pain threshold index (PTI) holds potential as a tool for monitoring analgesia-pain equilibrium, its precision in forecasting postoperative pain in children remains unconfirmed. This study's primary aim was to assess the PTI's predictive precision for postoperative pain.Methods: Children (aged 2–16 years) undergoing general surgery under general anesthesia were included. Within 5 min prior to the patient's emergence from surgery, data including PTI, wavelet index (WLI), heart rates (HR) and mean arterial pressure (MAP) were collected. Subsequently, a 15-min pain assessment was conducted following the patient's awakening. The accuracy of these indicators in discerning between mild and moderate to severe postoperative pain was evaluated through receiver operating characteristic (ROC) analysis.Results: The analysis encompassed data from 90 children. ROC analysis showed that PTI was slightly better than HR, MAP and WLI in predicting postoperative pain, but its predictive value was limited. The area under the curve (AUC) was 0.659 [0.537∼0.780] and the optimal threshold was 65[64–67]. Sensitivity and specificity were determined at 0.90 and 0.50, respectively. In a multivariable logistic regression model, a higher predictive accuracy was found for a multivariable predictor combining PTI values with gender, BMI, HR and MAP (AUC, 0.768; 95%CI, 0.669–0.866). Upon further scrutinizing the age groups, PTI's AUC was 0.796 for children aged 9–16, 0.656 for those aged 4–8, and 0.601 for younger individuals.Conclusions: PTI, when used alone, lacks acceptable accuracy in predicting postoperative pain in children aged 2 to 16 years. However, when combined with other factors, it shows improved predictive accuracy. Notably, PTI appears to be more accurate in older children.

Sleep is crucial for human health, insufficient sleep or poor sleep quality may negatively affect sleep function and lead to a state of sleep deprivation. Sleep deprivation can result in various health problems, including chronic pain. The intricate relationship between sleep and pain is complex and intertwined, with daytime pain affecting sleep quality and poor sleep increasing pain intensity. The article first describes the influence of sleep on the onset and development of pain, and then explores the impact of daytime pain intensity on nighttime sleep quality and subsequent pain thresholds. However, the primary emphasis is placed on the pivotal role of oxidative stress in this bidirectional relationship. Although the exact mechanisms underlying sleep and chronic pain are unclear, this review focuses on the role of oxidative stress. Numerous studies on sleep deprivation have demonstrated that it can lead to varying degrees of increased pain sensitivity, while chronic pain leads to sleep deprivation and further exacerbates pain. Further research on the role of oxidative stress in the mechanism of sleep deprivation-induced pain sensitization seems reasonable. This article comprehensively reviews the current research on the interrelationship between sleep deprivation, pain and the crucial role of oxidative stress.

Purpose: Explore the median effective dose of ciprofol for inducing loss of consciousness in elderly patients and investigate how frailty influences the ED₅₀ of ciprofol in elderly patients. Patients and Methods: A total of 26 non-frail patients and 28 frail patients aged 65– 78 years, with BMI ranging from 15 to 28 kg/m², and classified as ASA grade II or III were selected. Patients were divided into two groups according to frailty: non-frail patients (CFS< 4), frail patients (CFS≥ 4). With an initial dose of 0.3 mg/kg for elderly non-frail patients and 0.25 mg/kg for elderly frail patients, using the up-and-down Dixon method, and the next patient’s dose was dependent on the previous patient’s response. Demographic information, heart rate (HR), oxygen saturation (SpO₂), mean blood pressure (MBP), and bispectral index (BIS) were recorded every 30 seconds, starting from the initiation of drug administration and continuing up to 3 minutes post-administration. Additionally, the total ciprofol dosage during induction, occurrences of hypotension, bradycardia, respiratory depression, and injection pain were recorded. Results: The calculated ED₅₀ (95% confidence interval [CI]) and ED₉₅ (95% CI) values for ciprofol-induced loss of consciousness were as follows: 0.267 mg/kg (95% CI 0.250– 0.284) and 0.301 mg/kg (95% CI 0.284– 0.397) for elderly non-frail patients; and 0.263 mg/kg (95% CI 0.244– 0.281) and 0.302 mg/kg (95% CI 0.283– 0.412) for elderly frail patients. Importantly, no patients reported intravenous injection pain, required treatment for hypotension, or experienced significant bradycardia. Conclusion: Frailty among elderly patients does not exert a notable impact on the median effective dose of ciprofol for anesthesia induction. Our findings suggest that anesthesiologists may forego the necessity of dosage adjustments when administering ciprofol for anesthesia induction in elderly frail patients.