Medicine

BackgroundEffective postoperative analgesia is therefore critical for patients undergoing thoracoscopic surgery. Ultrasound-guided erector spinae plane block (ESPB) has demonstrated efficacy in reducing postoperative pain following thoracoscopic procedures; however, limited research exists regarding the minimum effective volume (MEV) of local anesthetic required. This study employed the biased coin up-and-down sequential method (BCD-UDM) to determine the MEV of 0.5% ropivacaine for ESPB in patie...

BackgroundPost-anesthetic tracheal extubation can lead to critical adverse events (AEs) in children due to their intolerance to hypoxia. However, evidence from pediatric studies on the factors associated with safe tracheal extubation is limited. We will investigate the incidence and risk factors of AEs associated with tracheal extubation using real-world data from Japan. This study aims to test the following hypotheses: extubation-related AEs are associated with (a) several indicative signs of c...

BackgroundIntraoperative opioid administration for cardiac surgery varies greatly, with most of this variability arising from anesthesiologist and institutional practices. Anesthesiologists administer intraoperative opioids via intermittent boluses and continuous infusions. Real-world data have shown infusion administration to be a strong determinant of high intraoperative opioid exposure, but whether bolus or infusion administration of sufentanil affects post-operative outcomes is unknown. Met...

Purpose To quantify and compare the peak force applied on the glottis during endotracheal intubation across five laryngoscopy techniques, two intubation conditions (standard and simulated laryngospasm), and two operator experience levels, and to assess the effects of stylet use and operator anthropometric characteristics on applied force. Methods This prospective, manikin-based experimental study enrolled 50 operators (30 experienced, 20 less experienced). Each performed endotracheal intubation ...

BackgroundAlthough transnasal transsphenoidal (TNTS) resection is the standard treatment for pituitary adenomas, the procedure carries a risk of hypothalamic-pituitary-adrenal (HPA) axis disruption. This potential for hypocortisolism often prompts the empiric use of perioperative steroids to mitigate hemodynamic instability. However, there is a paucity of data strictly correlating serum cortisol concentrations with intraoperative blood pressure fluctuations. This study sought to evaluate the rel...

OBJECTIVESAlthough several systematic reviews attempted to compare supraglottic airway (SGA) and endotracheal intubation for or adults with out-of-hospital cardiac arrest (OHCA), the optimal airway management strategy remains debated. We conducted a systematic review and meta-analysis comparing supraglottic airway (SGA) devices and endotracheal intubation (ETI) as initial interventions in OHCA to clarify their relative clinical efficacy. DATA SOURCESWe retrieved relevant clinical trials from Pu...

BackgroundOptical Coherence Tomography Angiography (OCTA) provides high-resolution visualization of retinal microvasculature, with vascular density (VD) serving as a one of the key quantitative metrics. However, VD measurements are highly sensitive to image binarization step, and no standardized approach exists. MethodsWe analyzed 51 OCTA scans (human and porcine) using 29 binarization algorithms, including global and local thresholding techniques from ImageJ and DoxaPy, as well as Random Walke...

BackgroundSex disparities in the delivery of care and in-hospital outcomes following ST-segment elevation myocardial infarction (STEMI) remain a global concern. We performed an updated global meta-analysis comparing clinical outcomes between males and females with STEMI. MethodsThis study was conducted according to PRISMA guidelines (PROSPERO CRD42024612510). We searched major electronic databases from 1st January 2000 to 7th November 2024. Pairwise meta-analysis was performed on outcomes relat...

Cervical nerve blocks require high precision due to the proximity of critical structures, such as the spinal cord and the vertebral and carotid arteries. Training opportunities are limited by the risks associated with fluoroscopy-guided procedures, ethical constraints of cadaveric models, and the high cost of commercial simulators. Three-dimensional (3D) printing offers an accessible and customizable alternative for procedural training. A cervical spine simulator was constructed from a multislic...

Background: Cesarean section is one of the most commonly performed surgical procedures worldwide and is frequently associated with moderate to severe postoperative pain. While overall pain after cesarean delivery is well described, evidence comparing pain intensity and analgesic use between primary and repeat cesarean sections remains limited. Objective: To compare postoperative pain severity and total analgesic consumption within the first 24 hours among women undergoing primary versus repeat c...

BackgroundUp to 15% of patients worldwide experience serious postoperative complications after major surgery. We explored the genetic basis of five common postoperative complications and whether they share genetic aetiology with their non-postoperative equivalents. MethodsWe performed case-control genome-wide association studies (GWAS) using UK Biobank data from >140,000 participants. The primary outcomes were postoperative acute kidney injury (AKI), atrial fibrillation (AF), myocardial infarct...

BackgroundPropofol dosing guidelines recommend age-based reductions because hypnotic sensitivity increases in older adults. Most real-world evaluations of induction practice, however, have relied on total weight-normalized dose (mg/kg) rather than estimating cerebral exposure using pharmacokinetic models. Because age-related pharmacokinetic changes alter the relationship between administered dose and peak effect-site concentration (Ce,max), mg/kg surrogates may misrepresent true age-dependent ex...

ObjectiveTo compare the efficacy and safety of etomidate versus ketamine as induction agents for rapid sequence intubation in critically ill adults, focusing on 28-day mortality and post-intubation hypotension. Data SourcesPubMed, Embase, and the Cochrane Library were systematically searched from inception to January 2026. Reference lists of included studies were also manually screened. Study SelectionWe included randomized controlled trials (RCTs) comparing single-dose intravenous ketamine ve...

INTRODUCTIONRisks for postoperative cognitive dysfunction remain poorly understood. Traditional cognitive screening tools such as the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) are used for perioperative cognitive evaluation but have limited scope, whereas comprehensive in-person testing poses problems for long-term follow up. METHODSThis prospective cohort study assesses the feasibility of using a remotely performed comprehensive neurocognitive test batte...

Rapid prediction of the severity of acute coronary syndrome (ACS) is crucial for appropriate intervention in emergency department. Neutrophils (Neu), lymphocytes (Lym) and monocytes (Mon) and their ratios (Neu/Lym, NLR; Mon/Lym, MLR NeuxMon/Lym, SIRI) are acknowledged to be associated with the prediction of the severity and adverse outcome of ACS patients. Here, we analysed retrospectively eosinophils (Eos) and Eos-derived novel ratios (Neu/Eos, NER; Mon/Eos, MER; Neu x Mon/Eos, SIII; Neu/Eos x ...

BackgroundThere is disparity between the incidence of malignant hyperthermia (MH) reactions and the prevalence of variants in the RYR1 gene associated with susceptibility to MH (where susceptibility is determined by in vitro contracture tests). Our aims were to use clinical and genetic data from the UK to explain this disparity and to examine if these data are consistent with the clinical risk of MH being inherited as an autosomal dominant trait. MethodsClinical MH and genotyping data were extr...

This study aimed to systematically review and critically evaluate the risk of bias and applicability of surgical site infection (SSI) risk prediction models after spinal surgery. China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database (VIP), SinoMed, PubMed, Web of Science, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and Embase were searched from inception to April 10, 2025. The prediction model risk of bias ass...

BackgroundInterstitial lung diseases (ILDs), including idiopathic pulmonary fibrosis (IPF) and connective tissue disease-associated ILD (CTD-ILD), share similar features that complicate diagnosis. Tumor markers are often elevated in ILD, yet their diagnostic utility remains unclear. MethodsThis retrospective study included ILD patients hospitalized between 2018 and 2025. Serum levels of alpha-fetoprotein, carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 199, CA125, CA153, neuron-specif...

The ERS/ATS22 interpretative flowchart classifies diffusing capacity (DLco) into 5 scenarios with associated pathophysiology, and has not been tested on large patient groups. We aimed to obtain a more layered DLco interpretation, by interrogating DLco components Kco and VA, and by estimating lung inflation during the DLco test to identify the presence of restriction, which crucially impacts Kco interpretation. By assessing a "low VA" against lung inflation, a novel 9-scenario DLco classification...

BackgroundAccurate differentiation of benign and malignant focal liver lesions (FLLs) is essential for clinical decision-making. Magnetic resonance elastography (MRE) and diffusion-weighted imaging (DWI) are advanced MRI techniques used for noninvasive lesion characterization, but their comparative diagnostic performance has not been definitively established. ObjectiveTo systematically compare the diagnostic accuracy of MRE and DWI for distinguishing benign from malignant FLLs. MethodsA system...